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v1.0.0
ICD-10 Guide
ICD-10 CodesR60.0

R60.0

Localized edema

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

Code Description

ICD-10 R60.0 is a billable code used to indicate a diagnosis of localized edema.

Key Diagnostic Point:

Localized edema refers to the accumulation of excess fluid in a specific area of the body, leading to swelling. This condition can occur due to various underlying causes, including inflammation, injury, or obstruction of lymphatic drainage. Common symptoms associated with localized edema include visible swelling, tenderness, and sometimes pain in the affected area. Clinicians may observe signs such as pitting edema, where pressing on the swollen area leaves an indentation, or non-pitting edema, which does not leave an indentation. Localized edema can be a manifestation of conditions such as venous insufficiency, heart failure, or localized infections. Laboratory findings may include elevated inflammatory markers or imaging studies that reveal underlying causes such as deep vein thrombosis or tumors. Accurate diagnosis often requires a thorough clinical history, physical examination, and possibly imaging or laboratory tests to identify the underlying cause of the edema.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes requiring differential diagnosis
  • Potential for overlapping symptoms with other conditions
  • Need for precise documentation of location and characteristics of edema
  • Variability in clinical presentation based on patient demographics

Audit Risk Factors

  • Inadequate documentation of the cause of edema
  • Failure to specify the location of edema
  • Misuse of related codes leading to incorrect coding
  • Lack of supporting clinical evidence for the diagnosis

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed history of present illness, physical examination findings, and any relevant lab results.

Common Clinical Scenarios

Patients presenting with unilateral leg swelling due to venous insufficiency or localized infection.

Billing Considerations

Ensure to document the duration, severity, and any associated symptoms to support the diagnosis.

Emergency Medicine

Documentation Requirements

Acute assessment findings, including vital signs and immediate interventions.

Common Clinical Scenarios

Patients with sudden onset of localized edema due to trauma or allergic reactions.

Billing Considerations

Document any immediate treatments provided and the patient's response to those treatments.

Coding Guidelines

Inclusion Criteria

Use R60.0 When
  • Follow official ICD
  • CM guidelines for coding symptoms and signs
  • Ensure that the diagnosis is supported by clinical documentation and that the specific location of edema is clearly indicated

Exclusion Criteria

Do NOT use R60.0 When
No specific exclusions found.

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

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

Documentation Requirements

Document the history, examination, and medical decision-making related to the edema.

Specialty Considerations

Ensure that the visit level reflects the complexity of the evaluation.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of localized edema, improving the ability to capture the nuances of patient presentations and underlying causes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of localized edema, improving the ability to capture the nuances of patient presentations and underlying causes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of localized edema, improving the ability to capture the nuances of patient presentations and underlying causes.

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

What is the difference between localized edema and generalized edema?

Localized edema refers to swelling in a specific area of the body, while generalized edema involves swelling throughout the body. Accurate coding requires distinguishing between the two based on clinical findings.