What is the ICD-10 code for a patient experiencing peripheral (peripheral) edema and pruritis (itching) due to chemotherapy?

ICD-10 Coding for Peripheral Edema and Pruritus Due to Chemotherapy

For a patient experiencing peripheral edema and pruritus secondary to chemotherapy, use R60.0 (localized edema) for the edema and L29.9 (pruritus, unspecified) for the itching, with an additional code from T45.1X5A (adverse effect of antineoplastic and immunosuppressive drugs, initial encounter) to capture the chemotherapy-related etiology.

Primary Diagnosis Codes

For Peripheral Edema

• R60.0 - Localized edema is the appropriate code for chemotherapy-induced peripheral edema affecting the extremities 1
• This code specifically captures localized fluid retention in the limbs, which is a well-documented adverse effect of chemotherapeutic agents, particularly gemcitabine (occurring in up to 20% of patients) and docetaxel 1, 2

For Pruritus

• L29.9 - Pruritus, unspecified is the standard code for generalized itching without an underlying dermatosis 3
• If the pruritus is localized to specific areas, consider more specific codes such as L29.0 (pruritus ani), L29.2 (pruritus vulvae), or L29.3 (anogenital pruritus) 3

Essential Additional Code for Etiology

• T45.1X5A - Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter
• This code is mandatory to document that the symptoms are chemotherapy-related rather than disease progression or other causes 1
• Use T45.1X5D for subsequent encounters after the initial diagnosis 4

Clinical Context and Coding Pitfalls

Common Chemotherapy Agents Causing These Symptoms

• Gemcitabine causes peripheral edema in up to 20% of patients, with severe cases (grade II or higher) occurring in less than 1% 1
• Docetaxel-based chemotherapy significantly increases lymphedema risk (32% vs 20% at 2.5 years) and causes fluid retention 2
• Pruritus is a significant side-effect of biological cancer therapies, particularly epidermal growth factor inhibitors 3

Critical Coding Considerations

• Always exclude other causes before coding as chemotherapy-related: deep vein thrombosis, disease progression, infection, or cardiac/renal causes must be ruled out 1
• Patients with pre-existing edema are at higher risk for severe chemotherapy-induced edema and may require different coding if the edema represents exacerbation of a chronic condition 1
• The temporal relationship to drug administration is essential for accurate coding - most reactions occur after the first cycle of chemotherapy 5

When to Use Alternative Codes

• If the edema is generalized rather than localized to extremities, use R60.1 (generalized edema) instead 1
• If there is an associated rash with the pruritus (such as flagellate dermatitis from bleomycin or docetaxel), use L27.0 (generalized skin eruption due to drugs) instead of L29.9 5
• For lymphedema specifically related to breast cancer treatment with docetaxel, consider I97.2 (postmastectomy lymphedema syndrome) if applicable 2

Documentation Requirements

• Document the specific chemotherapy agent causing the reaction, as this affects treatment decisions and future drug selection 3
• Record the severity grade (mild, moderate, severe) as this impacts whether chemotherapy can be continued 1
• Note whether symptoms required drug discontinuation, as severe peripheral edema (grade II or higher) often necessitates suspension of gemcitabine and corticosteroid treatment 1