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v1.0.0
ICD-10 Guide
ICD-10 CodesR60.1

R60.1

Generalized edema

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

Code Description

ICD-10 R60.1 is a billable code used to indicate a diagnosis of generalized edema.

Key Diagnostic Point:

Generalized edema refers to the swelling that occurs throughout the body due to the accumulation of excess fluid in the interstitial spaces. This condition can manifest as noticeable swelling in various areas, including the limbs, abdomen, and face. It is often a sign of underlying health issues, such as heart failure, kidney disease, liver dysfunction, or malnutrition. Patients may present with symptoms such as weight gain, tightness in the skin, and discomfort. The clinical evaluation of generalized edema typically involves a thorough history and physical examination, focusing on the duration, severity, and associated symptoms. Laboratory tests may include serum albumin levels, renal function tests, and imaging studies to assess fluid status and identify potential causes. Understanding the etiology of generalized edema is crucial for effective management and treatment, as it can indicate serious systemic conditions requiring prompt intervention.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes requiring differential diagnosis
  • Potential overlap with other edema-related codes
  • Need for comprehensive documentation to support the diagnosis
  • Variability in clinical presentation among patients

Audit Risk Factors

  • Inadequate documentation of the underlying cause of edema
  • Failure to differentiate between generalized and localized edema
  • Lack of supporting lab results or clinical findings
  • Misuse of R60.1 when a more specific code is applicable

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed patient history, physical examination findings, and lab results indicating fluid status.

Common Clinical Scenarios

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

Billing Considerations

Ensure documentation reflects the severity and duration of edema, as well as any associated symptoms.

Emergency Medicine

Documentation Requirements

Acute assessment findings, including vital signs and immediate lab results.

Common Clinical Scenarios

Patients presenting with acute generalized edema due to anaphylaxis or acute kidney injury.

Billing Considerations

Document the acute nature of the presentation and any interventions performed.

Coding Guidelines

Inclusion Criteria

Use R60.1 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation and that all relevant symptoms and findings are captured

Exclusion Criteria

Do NOT use R60.1 When
No specific exclusions found.

Related CPT Codes

99214CPT Code

Established patient office visit, level 4

Clinical Scenario

Used when managing chronic conditions with generalized edema.

Documentation Requirements

Document history, examination, and medical decision-making.

Specialty Considerations

Internal medicine providers should ensure comprehensive documentation of the patient's condition.

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 presentations and their underlying causes.

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 presentations and their underlying causes.

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 presentations and their 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 generalized edema and localized edema?

Generalized edema refers to swelling that occurs throughout the body, while localized edema is confined to a specific area. Accurate coding requires distinguishing between the two based on clinical findings.