Oncology & Hematology Coding Alert

Acute vs. chronic duration guides you to the correct code.

Confused over enlarged and inflamed lymph node coding? Not all ICD-9 codes have a direct one-to-one match. Reporting the lymph node involvement is easy provided you know how to make your way to the most precise code.

Check Localized vs. Generalized for Enlarged Lymph Nodes

When your physician documents enlarged lymph nodes without a more specific diagnosis, you report ICD-9-CM code 785.6 (Enlargement of lymph nodes).

In ICD-10-CM, you will report code R59.0 (Localized enlarged lymph nodes) or R59.1 (Generalized enlarged lymph nodes), depending upon whether the lymph node enlargement is localized or generalized. However, if your physician does not document localized or generalized, you’ll report ICD-10-CM code R59.9 (Enlarged lymph nodes, unspecified).

Look for a One-to-One Match for Chronic Lymphadenitis

When reporting chronic lymphadenitis, you submit ICD-9-CM code 289.1 (Chronic lymphadenitis). However, in ICD-10-CM, this maps to I88.1 (Chronic lymphadenitis, except mesenteric).

What is new in ICD-10-CM? The only difference in ICD-10-CM is that the code descriptor for I88.1 clearly specifies the code does not apply to chronic mesenteric lymphadenitis. You have specific codes for mesenteric lymphadenitis.

Be Site Specific for Acute Lymphadenitis

When reporting an acute case of lymphadenitis, you report ICD-9-CM code 683 (Acute lymphadenitis). This code maps to the following ICD-10-CM codes:

• L04.0, Acute lymphadenitis of face, head and neck
• L04.1, Acute lymphadenitis of trunk
• L04.2, Acute lymphadenitis of upper limb
• L04.3, Acute lymphadenitis of lower limb
• L04.8, Acute lymphadenitis of other sites

How is ICD-10-CM different? ICD-10-CM offers codes for acute lymphadenitis according to the anatomical site of the enlarged lymph nodes. You should make sure your physician documents which lymph nodes in specific are involved. When your physician does not specify the location or site of the acute lymphadenitis, you’ll submit ICD-10-CM code L04.9 (Acute lymphadenitis, unspecified).

Not sure if acute or chronic? When your physician does not specify whether the lymphadenitis is acute or chronic, you report ICD-9-CM code 289.3 (Lymphadenitis unspecified except mesenteric), which maps to two codes in ICD-10-CM (i.e., I88.9, Nonspecific lymphadenitis, unspecified and I88.8, Other nonspecific lymphadenitis)

Look for Definitive Option for Mesenteric Lymphadenitis

When reporting mesenteric lymphadenitis, you report ICD-9-CM code 289.2 (Nonspecific mesenteric lymphadenitis). Unlike the lymphadenitis for other sites, you do not have different codes for acute and chronic cases of mesenteric lymphadenitis. The ICD-9-CM code 289.2 maps to ICD-10-CM code I88.0 (Nonspecific mesenteric lymphadenitis).

Note: You should always report the code with the highest specificity. If you want to avoid a denial, you may need to query the physician for more information. Encourage your physicians to begin including more information in their notes now to avoid future hassles.