ICD Code R91.1

ICD code R91.1 is a medical classification used to identify a solitary pulmonary nodule, which is a single abnormal round or oval spot in the lung that is typically discovered through imaging tests such as a chest X-ray or CT scan. This code is used by healthcare providers to document and track the diagnosis for billing and treatment purposes.

1. Presence of a Single Nodule: The patient must present with a solitary nodule in the lung, as opposed to multiple nodules or masses.

2. Nodule Size: The nodule is typically defined as being between 3 mm and 30 mm in diameter. Nodules smaller than this range may be classified differently, while larger masses may require alternative diagnostic codes.

3. Radiological Evidence: The nodule should be identified through imaging studies such as a chest X-ray or CT scan, which clearly shows a distinct, isolated nodule.

4. Absence of Symptoms: Often, solitary pulmonary nodules are asymptomatic and discovered incidentally during imaging for other reasons. However, if symptoms are present, they should not be attributable to the nodule itself.

5. No Immediate Signs of Malignancy: Initial imaging should not show definitive signs of malignancy, such as irregular borders, spiculation, or rapid growth, which would necessitate further investigation and potentially a different coding.

6. Exclusion of Infectious Causes: The nodule should not be immediately attributable to infectious processes such as tuberculosis or fungal infections, which would require specific diagnostic codes.

7. Patient History Consideration: The patient's medical history should be reviewed to rule out previous conditions or treatments that could explain the presence of the nodule, such as prior surgeries or known benign conditions.

8. Follow-Up Recommendations: The use of this code often implies the need for follow-up imaging to monitor the nodule for changes in size or characteristics over time, which could indicate a need for further diagnostic evaluation.

For the ICD code R91.1, which pertains to a solitary pulmonary nodule, the relevant CPT codes that may be used for treatment or diagnostic procedures include:

1. CPT 71250 - CT scan of the thorax without contrast material.
2. CPT 71260 - CT scan of the thorax with contrast material.
3. CPT 71270 - CT scan of the thorax without and with contrast material.
4. CPT 31622 - Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with or without cell washing (separate procedure).
5. CPT 31628 - Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe.
6. CPT 31629 - Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), each additional lobe.
7. CPT 32405 - Biopsy, lung or mediastinum, percutaneous needle.
8. CPT 32607 - Thoracoscopy, surgical; with diagnostic biopsy(ies) of lung infiltrate(s) (e.g., wedge, incisional), unilateral.
9. CPT 32608 - Thoracoscopy, surgical; with diagnostic biopsy(ies) of pleura.
10. CPT 32609 - Thoracoscopy, surgical; with diagnostic biopsy(ies) of mediastinal or pericardial mass (e.g., lymphoma), unilateral.

These CPT codes are typically used in the diagnostic evaluation and management of a solitary pulmonary nodule, as indicated by ICD code R91.1. It's important for healthcare providers to select the appropriate CPT code based on the specific procedure performed and the clinical context.

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