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ICD-10 Guide
ICD-10 CodesR91

R91

Abnormal findings on diagnostic imaging of lung

BILLABLE STATUSNo
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 R91 is a used to indicate a diagnosis of abnormal findings on diagnostic imaging of lung.

Key Diagnostic Point:

The ICD-10 code R91 is designated for abnormal findings on diagnostic imaging of the lung, which encompasses a variety of conditions that may not have specific diagnoses but are noted during imaging studies such as X-rays, CT scans, or MRIs. This category includes findings such as nodules, masses, infiltrates, and other anomalies that may indicate underlying pulmonary diseases or conditions. The clinical significance of these findings is paramount, as they can lead to further diagnostic evaluation and management of potential respiratory disorders, including infections, malignancies, and chronic lung diseases.

  • Usage of R91 codes is critical in the context of diagnostic imaging where the findings are abnormal but not yet classified under a specific disease category. Clinicians must ensure that these codes are used accurately to reflect the findings observed in imaging studies. It is essential to document the imaging results thoroughly, as this will support the use of R91 codes and guide subsequent patient management and treatment plans.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of conditions covered
  • Need for further diagnostic clarification
  • Potential for overlapping codes

Audit Risk Factors

  • Inadequate documentation of imaging results
  • Misuse of codes leading to denials
  • Failure to follow up on abnormal findings

Specialty Focus

Medical Specialties

Pulmonology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Radiology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related Codes

Child Codes

2 codes
R91.1
Solitary pulmonary nodule
R91.8
Other nonspecific abnormal finding of lung field

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical impact of the R91 code category is significant, as it plays a crucial role in identifying potential lung conditions that may require further evaluation or intervention. By accurately coding abnormal imaging findings, healthcare providers can ensure that patients receive appropriate follow-up care, which can lead to early detection and treatment of serious conditions such as lung cancer or chronic obstructive pulmonary disease (COPD). This proactive approach not only improves patient outcomes but also contributes to overall population health by addressing respiratory issues at an early stage.
From an administrative perspective, the use of R91 codes can influence quality measures and healthcare trends, as they highlight the importance of thorough diagnostic imaging and follow-up care. Tracking the frequency and types of abnormal findings can provide valuable data for healthcare organizations to improve their diagnostic processes and patient management strategies. Furthermore, as healthcare systems increasingly focus on value-based care, the accurate use of R91 codes can help demonstrate the quality of care provided to patients with respiratory conditions.

ICD-9 vs ICD-10

The clinical impact of the R91 code category is significant, as it plays a crucial role in identifying potential lung conditions that may require further evaluation or intervention. By accurately coding abnormal imaging findings, healthcare providers can ensure that patients receive appropriate follow-up care, which can lead to early detection and treatment of serious conditions such as lung cancer or chronic obstructive pulmonary disease (COPD). This proactive approach not only improves patient outcomes but also contributes to overall population health by addressing respiratory issues at an early stage. From an administrative perspective, the use of R91 codes can influence quality measures and healthcare trends, as they highlight the importance of thorough diagnostic imaging and follow-up care. Tracking the frequency and types of abnormal findings can provide valuable data for healthcare organizations to improve their diagnostic processes and patient management strategies. Furthermore, as healthcare systems increasingly focus on value-based care, the...

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, but it is crucial to provide comprehensive documentation that supports the necessity of the imaging and any subsequent evaluations or treatments. Additionally, common billing practices include ensuring that the codes are linked to the appropriate CPT codes for the imaging services performed.

Resources

Clinical References

  • •
    Official ICD-10 Guidelines for R91

Coding & Billing References

  • •
    Official ICD-10 Guidelines for R91

Frequently Asked Questions

What conditions are included in R91?

R91 includes abnormal findings such as lung nodules, masses, infiltrates, and other unspecified anomalies detected during imaging studies.

When should I use R91 codes?

R91 codes should be used when imaging results indicate abnormal findings that do not have a specific diagnosis but require further evaluation or monitoring.

What documentation is required for R91?

Documentation must include detailed imaging results, the clinical context of the findings, and any recommendations for further diagnostic testing or follow-up.