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v1.0.0
ICD-10 Guide
ICD-10 CodesR60

R60

Edema, not elsewhere classified

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 R60 is a billable code used to indicate a diagnosis of edema, not elsewhere classified.

Key Diagnostic Point:

Edema refers to the abnormal accumulation of fluid in the interstitial spaces of tissues, leading to swelling. This condition can manifest in various parts of the body, including the extremities, abdomen, and lungs. Edema can be classified as localized or generalized, with the latter often indicating systemic issues. Common causes of edema include heart failure, renal dysfunction, liver disease, and venous insufficiency. Symptoms may include visible swelling, discomfort, and restricted movement in affected areas. Laboratory findings may reveal electrolyte imbalances or renal function abnormalities. Accurate diagnosis requires a thorough clinical evaluation, including patient history, physical examination, and potentially imaging studies or laboratory tests to identify underlying causes. R60 is used when edema is present but does not fit into more specific categories, necessitating careful documentation to ensure appropriate coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes that can lead to edema.
  • Need for comprehensive patient history and physical examination.
  • Potential overlap with other conditions that may cause similar symptoms.
  • Documentation must clearly indicate the absence of more specific diagnoses.

Audit Risk Factors

  • Inadequate documentation supporting the diagnosis of edema.
  • Failure to specify the location or cause of edema.
  • Use of R60 when a more specific code is applicable.
  • Inconsistent coding practices across different providers.

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed patient history, physical examination findings, and any relevant lab results.

Common Clinical Scenarios

Patients presenting with chronic conditions such as heart failure or renal disease exhibiting edema.

Billing Considerations

Ensure that the underlying cause of edema is documented to support the diagnosis.

Emergency Medicine

Documentation Requirements

Acute care notes, including vital signs and immediate lab results.

Common Clinical Scenarios

Patients with sudden onset edema due to allergic reactions, trauma, or acute heart failure.

Billing Considerations

Document the acute nature and any interventions performed to manage the edema.

Coding Guidelines

Inclusion Criteria

Use R60 When
  • Coders should refer to the ICD
  • CM Official Guidelines for Coding and Reporting, ensuring that the diagnosis is supported by clinical documentation
  • R60 should only be used when no other more specific code applies

Exclusion Criteria

Do NOT use R60 When
No specific exclusions found.

Related Codes

Child Codes

3 codes
R60.0
Localized edema
R60.1
Generalized edema
R60.9
Edema, unspecified

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used when evaluating a patient with edema in an outpatient setting.

Documentation Requirements

Document the patient's history, examination findings, and any treatment plans.

Specialty Considerations

Internal medicine providers should ensure comprehensive documentation to support the visit level.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of edema, improving the ability to capture the complexity of patient conditions. R60 serves as a catch-all for edema not classified elsewhere, but coders must ensure accurate documentation to avoid denials.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of edema, improving the ability to capture the complexity of patient conditions. R60 serves as a catch-all for edema not classified elsewhere, but coders must ensure accurate documentation to avoid denials.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of edema, improving the ability to capture the complexity of patient conditions. R60 serves as a catch-all for edema not classified elsewhere, but coders must ensure accurate documentation to avoid denials.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

When should I use R60?

Use R60 when edema is present but does not fit into more specific categories. Ensure that documentation supports the diagnosis.

What are common causes of edema?

Common causes include heart failure, renal dysfunction, liver disease, and venous insufficiency.