Refresher: What are ICD-10 codes?

The ICD-10, short for International Classification of Diseases, is used for coding medical records in healthcare settings [1]. It was developed by the World Health Organization and modified for clinical settings by the Centers for Disease Control and Prevention for use in US healthcare organizations [2].

The modified version of the ICD-10 is known as ICD-10-CM, and as the name suggests, it is the 10th revision of the ICD. It contains more than 68,000 codes, compared to around 13,000 codes in the ICD-9. This is primarily because ICD-10 codes aim for a higher level of accuracy, including the complexity, severity, and location of the medical condition [3].

There is a marked increase in the complexity of ICD codes, which helps improve specificity in clinical database research. The first character of the ICD-10 begins with an alpha letter (other than ‘u’). The second and third characters are numeric, and the remaining characters (fourth through seven) may be a combination of numbers and letters.

All healthcare professionals and medical coders in the US are required to use codes I00 through I99 for diseases of the circulatory system. Here are a few examples:

• I00 through I02 are applicable to acute rheumatic fever
• I05 through I09 are used for chronic rheumatic heart disease
• I10 through I16 are used for hypertensive diseases
• I80 through I89 are used for disease of veins, lymphatic vessels, and lymph noose, not elsewhere classified
• And I95 through I99 are used for other and unspecified diseases of the circulatory system

What is the ICD 10 code for Lymphedema?

For lymphedema, the general ICD-10 code is I89.0 (lymphedema, not elsewhere classified) and is applicable to lymphangiectasis, praecox lymphedema, and secondary lymphedema, among others. It should not be confused with postmastectomy lymphedema (I97.2), a type of swelling that occurs after the removal of lymph nodes during cancer surgery.

Lymphedema ICD 10 code: I89.0

Lymphedema ICD code I89.0 Lookup

The ICD 10 lymphedema code for localized tissue swelling is I89.0, “lymphedema, not elsewhere classified [4]. There are no other ICD-10 codes for lymphedema, and it excludes postmastectomy lymphedema (I97.2).

Lymphedema itself is relatively rare and only affects about 1 in 100,000 individuals, with secondary lymphedema affecting about 1 in 1000 Americans [5]. Patients with lymphedema may notice swelling in their arms, legs, and other parts of the body. The swelling occurs due to the buildup of lymph fluid in the body.

It helps to think of lymph nodes as drains in a sink. A clogged drain won’t provide an outlet for the fluid to drain out. The most common causes of lymphedema are cancer, radiation treatment for cancer, and surgery. Parasites that clog the lymph nodes can also cause lymphedema. In addition, there are several risk factors that can increase one’s likelihood of getting lymphedema, including:

• Older age
• Excess weight
• Rheumatoid arthritis
• Psoriatic arthritis

Diagnosing lymphedema can be challenging and is often diagnosed at a late stage in the case of primary lymphedema. The patient’s medical history and a physical exam are used to help diagnose lymphedema. Note that there is no specific test or tool to diagnose lymphedema. With that said, there are a few tests that may indicate lymphedema, including:

• Doppler ultrasound: Analyzes blood flow and finds obstructions that could rule out other possible causes of swelling, such as blood clots
• MRI scans: These scans are used to provide a detailed image of the body and find out if tumors are applying pressure on the lymphatic system
• CT scans: These scans provide detailed cross-sectional images of the body’s structure and are used to check if something is applying pressure on the lymphatic system

The symptoms of lymphedema are very similar to other medical conditions, such as infantile hemangioma, venous malformation, ParkesWeber syndrome, and lipedema, among others. Although there is a large interindividual variability in the symptoms that patients may experience, the following symptoms are commonly reported:

• Restricted mobility
• Skin infections
• Formation of hardened, thickened skin
• Folds developed in the skin
• Wart-like growth in the skin
• Fluids leaking through the skin
• A heavy feeling

Although there is no cure for lymphedema, it is possible to use various therapies to control the main symptoms. The primary goal of treatments is to minimize the buildup of fluid and stimulate the flow of fluid through the lymphatic system. Most treatments depend on the severity and extent of the lymphedema.

The following options are prioritized when treating lymphedema:

• Exercising to restore flexibility and strength to improve drainage
• Wearing a customized compression sleeve to prevent the buildup of fluid
• Applying an arm pump to increase the flow of fluid in the lymphatic system
• Eating a well-balanced diet to maintain a healthy body weight
• Keeping the arm raised above the level of the heart to use gravity to drain the accumulated fluid
• Prevention of infection to protect the affected arm from infection and skin breakdown

Types of lymphedemas coded under I89.0

The ICD 10 code I89.0 does not specify the type of lymphedema. An I89.0 code can be used for lymphedema of various types, as will be seen below:

• Bilateral arm lymphedema
• Bilateral leg lymphedema
• Chronic acquired lymphedema
• Left arm lymphedema (swelling from lymph obstruction)
• Left leg lymphedema (swelling from lymph obstruction)
• Lymphedema (swelling from lymph obstruction)
• Lymphedema of right lower limb
• Lymphedema of right upper limb
• Lymphedema of bilateral lower limbs
• Lymphedema of bilateral upper limbs
• Lymphedema of left lower limb
• Lymphedema of left upper limb
• Lymphedema of penis
• Lymphedema of the penis (swelling from lymph obstruction)
• Lymphedema of scrotum
• Lymphedema of the scrotum (swelling from lymph obstruction)
• Lymphedema praecox
• Lymphedema, after surgery
• Nonfilarial elephantiasis
• Post radiation lymphedema
• Postsurgical lymphedema
• Right arm lymphedema (swelling from lymph obstruction)
• Right leg lymphedema (swelling from lymph obstruction)
• Lymphedema caused by radiation
• Elephantiasis (nonfilarial) NOS
• Lymphangiectasis
• Obliteration, lymphatic vessel
• Praecox lymphedema
• Secondary lymphedema

In other words, right leg lymphedema (swelling from lymph obstruction) ICD 10, lymphedema of the scrotum (swelling from lymph obstruction) ICD 10, and left leg lymphedema (swelling from lymph obstruction) ICD 10 codes could all be I89.0 if they are determined to be localized tissue swelling due to the buildup of lymph fluid in the body. As a concrete example, a patient diagnosed with lymphedema caused by radiation would be coded with I89.0.

There are numerous advantages of upgrading to ICD-10 from ICD-90. The specificity of ICD-10 is superior to those of ICD-9, which allows for greater granularity in coding medical conditions. It also provides access to better data for tracking and measuring patient care. Retrieval of medical histories for patients also becomes easier because the data is stored in an organized and consistent manner.

With that said, ICD-10 isn’t without its disadvantages. For one, upgrading from ICD-9 to ICD-10 requires considerable resources in terms of money and time. The transition from ICD-9 to ICD-10 will result in a temporary lower productivity for the healthcare organization that could eat into their revenue.

Secondly, healthcare professionals and coders will be required to upgrade their certifications to match the requirements for the ICD-10-CM classification system. This means additional investment in classes and seminars that would cost money and time. For many healthcare professionals, taking the exam to pass certifications itself can be extremely expensive.

Finally, the high specificity of the ICD-10 system can be a disadvantage if the healthcare professional misidentifies the code. Miscoding often occurs because physicians are unable to collect enough data about the medical condition or because of the coder’s inexperience. In either case, the patient may be exposed to side effects from medications while their actual disease is allowed to get worse with time since it goes untreated.

Types of lymphedema excluded from ICD-10 I89.0

The ICD-10 I89.0 code does not include postmastectomy lymphedema syndrome, a type of swelling that occurs after the removal of the lymph nodes during cancer surgery. Postmastectomy lymphedema syndrome is coded under I97.2 and is applicable to the following synonyms:

• Postmastectomy lymphedema syndrome of bilateral upper limbs
• Postmastectomy lymphedema syndrome of both arms
• Postmastectomy lymphedema syndrome of the left arm
• Postmastectomy lymphedema syndrome of the left upper limb
• Postmastectomy lymphedema syndrome of the right arm
• Postmastectomy lymphedema syndrome of the right upper limb

It is also worth mentioning that many physicians are unfamiliar with postmastectomy lymphedema syndrome, which can lead to delayed diagnosis.

Conclusion

So there you have it, a detailed look at the ICD-10 code for lymphedema, I89.0. The medical condition is fairly rare in patients, and it can be difficult to diagnose because of overlapping symptoms from other diseases. Please note that the information in this article is only meant to be used for reference purposes and does not replace professional medical advice.

If you believe you have lymphedema, you should visit a medical expert at the earliest. You should also redirect any questions you may have about the ICD-10 codes discussed in this article.