Find comprehensive information on urticaria, including hives, wheals, angioedema, and chronic idiopathic urticaria. This resource covers clinical documentation, ICD-10 codes (L50), medical coding, diagnosis, treatment, and management of urticaria for healthcare professionals. Learn about allergy testing, dermatology referrals, and the different types of urticaria, from acute to chronic. Explore effective treatment options and best practices for documenting urticaria in medical records.
Also known as
Urticaria
Hives or nettle rash, a skin reaction causing itchy welts.
Adverse effects of drugs
Various side effects caused by medications, which can include urticaria.
Dermatitis and eczema
Inflammatory skin conditions sometimes associated with or mistaken for urticaria.
Angioneurotic edema
Swelling similar to urticaria, often occurring beneath the skin.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the urticaria due to a physical stimulus (e.g., dermographism, cold, heat, pressure)?
Yes
Dermographism?
No
Is the cause of the urticaria documented?
When to use each related code
| Description |
|---|
| Hives; raised itchy bumps |
| Angioedema; swelling beneath skin |
| Atopic dermatitis; eczema |
Coding L50.9 (Urticaria, unspecified) without sufficient documentation specifying the type or cause can lead to claim denials and inaccurate quality reporting.
Miscoding allergic urticaria (L50.0-L50.4) as non-allergic or vice-versa impacts reimbursement and may trigger audits due to differing clinical severity.
Incorrectly documenting and coding chronic urticaria (L50.8) instead of acute or specific types can lead to under-coding and lost revenue.
Q: What are the most effective diagnostic approaches for chronic spontaneous urticaria in adults, considering both first-line and second-line testing strategies?
A: Diagnosing chronic spontaneous urticaria (CSU) in adults primarily relies on a thorough clinical history and physical examination focusing on the characteristic wheals and/or angioedema. First-line testing should include a complete blood count (CBC) with differential, comprehensive metabolic panel (CMP), and erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) to rule out underlying infections or inflammatory conditions. While routine allergy testing is often not helpful in CSU, it may be considered in patients with suspected inducible urticaria or concomitant allergic rhinitis/asthma. Second-line investigations, pursued if initial tests are unrevealing or if specific triggers are suspected, can include thyroid function tests, antinuclear antibody (ANA) testing, complement levels (C3, C4), and, in rare cases, skin biopsy. Explore how a stepwise approach to diagnostic testing can improve CSU management. Consider implementing validated patient-reported outcome measures like the Urticaria Activity Score (UAS7) to monitor disease activity and treatment response.
Q: How can I differentiate between chronic inducible urticaria and chronic spontaneous urticaria in my clinical practice, and what specific physical exam findings or diagnostic tests are helpful?
A: Distinguishing between chronic inducible urticaria (CIndU) and chronic spontaneous urticaria (CSU) hinges on identifying specific triggers. CIndU presents with wheals and/or angioedema after exposure to identifiable stimuli like pressure, vibration, cold, heat, or sunlight. A detailed patient history is crucial, including questions about activities preceding symptom onset. Physical exam maneuvers, such as applying ice (cold urticaria), rubbing the skin (dermatographism), or applying pressure (delayed pressure urticaria), can be helpful in diagnosing CIndU subtypes. In contrast, CSU occurs without identifiable triggers. Diagnostic testing for CIndU involves specific challenge tests corresponding to suspected subtypes. Learn more about different types of CIndU and appropriate challenge protocols. For CSU, laboratory testing mainly serves to rule out other conditions, as described above.
Subjective: Patient presents with complaints of hives (urticaria), describing pruritic, raised, erythematous wheals of varying sizes. Onset of symptoms reported as [Timeframe - e.g., two days ago, several hours ago]. Patient denies fever, chills, or shortness of breath. Associated symptoms may include angioedema, itching (pruritus), and dermatographism. Patient reports [Triggers if known - e.g., recent medication change, new food ingestion, insect bite, stress]. Review of systems otherwise negative. Past medical history includes [Relevant medical history - e.g., eczema, asthma, allergies]. Current medications include [List medications]. Allergies include [List allergies]. Objective: Physical examination reveals multiple well-circumscribed, raised, erythematous wheals distributed on [Location - e.g., trunk, extremities, face]. Individual lesions range in size from [Size - e.g., a few millimeters to several centimeters]. No evidence of airway compromise or angioedema noted. Dermatographism [Positive or negative]. Vital signs stable. Heart, lung, and abdominal examinations unremarkable. Assessment: Diagnosis of acute urticaria is made based on the characteristic clinical presentation and history. Differential diagnoses considered include allergic reaction, drug eruption, and viral exanthem. Severity assessed as [Mild, moderate, or severe] based on symptom distribution, pruritus intensity, and presence or absence of systemic symptoms. Plan: Patient educated on the nature of urticaria, potential triggers, and management strategies. Recommended treatment includes [Treatment plan - e.g., oral antihistamines (H1 blockers like cetirizine or diphenhydramine), H2 blockers (like ranitidine or famotidine if indicated), short course of oral corticosteroids if severe, avoidance of identified triggers]. Patient advised to return for follow-up if symptoms worsen or do not resolve within [Timeframe - e.g., one week]. ICD-10 code L50.9 (Urticaria, unspecified) is assigned. Patient provided with information regarding anaphylaxis symptoms and emergency contact information. Emphasis placed on trigger avoidance and symptom management.