ICD-10 Coding for Solitary Pulmonary Nodule(R91.1)
Complete ICD-10-CM coding and documentation guide for Solitary Pulmonary Nodule. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Solitary Pulmonary Nodule
R91-R94Primary Range
Abnormal findings on diagnostic imaging and in function studies, without diagnosis
This range includes codes for abnormal findings on imaging studies, such as solitary pulmonary nodules.
Malignant neoplasm of bronchus and lung
Used when a solitary pulmonary nodule is confirmed to be malignant.
Key Information: ICD-10 code for solitary pulmonary nodule
Essential facts and insights about Solitary Pulmonary Nodule
Primary ICD-10-CM Code for solitary nodule of lung
Decision Criteria
clinical Criteria
- Nodule is solitary and <3 cm with no prior imaging for comparison.
coding Criteria
- No confirmed diagnosis from biopsy or lab tests.
Applicable To
- Coin lesion
- Solitary lung nodule
Clinical Validation Requirements
- Imaging showing a solitary nodule <3 cm
- No definitive diagnosis from biopsy or lab tests
Code-Specific Risks
- Using R91.1 when a definitive diagnosis exists can lead to claim denials.
Coding Notes
- Ensure no definitive diagnosis is present before using R91.1.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Pulmonary candidiasis
B37.1Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Malignant neoplasm of unspecified part of bronchus or lung
C34.90Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Solitary Pulmonary Nodule to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R91.1.
Impact
Clinical: May lead to inappropriate follow-up recommendations., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials due to insufficient documentation.
Mitigation Strategy
Use structured reporting templates., Ensure all relevant nodule characteristics are documented.
Impact
Reimbursement: May lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data representation in patient records.
Mitigation Strategy
Code the confirmed etiology first, such as malignancy or infection.
Impact
Improper use of R91.1 when a definitive diagnosis is present.
Mitigation Strategy
Implement coding audits to ensure compliance.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Solitary Pulmonary Nodule, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Solitary Pulmonary Nodule
Use these documentation templates to ensure complete and accurate documentation for Solitary Pulmonary Nodule. These templates include all required elements for proper coding and billing.
Initial Detection of SPN
Specialty: RadiologyRequired Elements
- Nodule size and location
- Density and margins
- Comparison with prior imaging
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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