Endocrinology Medical CodingThe endocrinology system consists of the pituitary gland, the pineal gland, thyroid and parathyroid glands, thymus, adrenal glands, pancreas, ovaries and testes. Medical terms related to the endocrine system are organized on the basis of conditions, diseases, diagnostic procedures and operations. Conditions include those related to the endocrine system glands and hormones, metabolic conditions and nutritional deficiency conditions. Endocrinology medical coding involves assigning the accurate diagnosis and procedure codes. The diagnostic codes are classified under

  • Disorders of the thyroid gland (240 -246.9)
  • Diseases of other endocrine glands (250 – 259.9)
  • Nutritional deficiencies (260 – 269.9)
  • Other metabolic disorders and immunity disorders (270 – 279.9)

Operations on the endocrine system are coded as (a) Operations on the thyroid and parathyroid glands (06) – these codes refer to aspiration, incision, excision and biopsy of the parathyroid and thyroid glands. (b) Operations on the other endocrine glands (07). These include incisions, exploration, excisions and biopsies of the pineal gland, pituitary gland, thymus and adrenal glands.

The categories of Nuclear Medicine (92) and Injection or infusion of therapeutic or prophylactic substance (99.1) in the ICD-9-CM listing also mention endocrine glands/hormones.

Endocrinology Diagnostic Tests that Are Coded

An endocrinologist employs diagnostic tests for many reasons. These include:

  • To find whether the endocrine glands are working perfectly
  • To measure the hormone levels in the patient’s body
  • To diagnose the reason for an endocrinology problem/condition
  • To confirm some earlier diagnosis

An endocrinologist may order tests such as:

  • ACTH stimulation test
  • CRH stimulation test
  • Bone density test
  • 24 hour urine collection test
  • Fine needle aspiration biopsy
  • Oral glucose tolerance test
  • Continuous glucose monitoring (CGM)
  • Dexamethasone suppression test
  • Semen analysis
  • 5 day glucose sensor test for diabetes
  • TSH blood test
  • Thyroid scan

Treatments Usually Recommended

According to the condition or disease, the endocrinologist offers suitable treatments, which can be billed for reimbursement.

  • Insulin pump
  • Parathyroid hormone therapy and Biphosphonate therapy for osteoporosis
  • Pituitary hormone replacement therapy
  • Male hormone replacement therapy
  • Thyroid hormone replacement therapy
  • Radioactive iodine therapy

Coding for Continuous Glucose Monitoring

Continuous glucose monitoring is an important procedure in endocrinology and is reported using the CPT codes 95250 and 95251.

  • 95250 – To report the technical component of CGM; for patient training, monitor calibration, glucose sensor placement, removal of sensor, use of a transmitter, downloading of data.

If the services are provided by a certified diabetic educator or a registered nurse under the supervision of a physician, the supervising physician can claim reimbursement for those services.

  • 95251 – To report analysis and interpretation of CGM data. It signifies the professional component and can be billed only by a physician, a nurse practitioner or physician assistant.

Face-to-face visits with the patient can be reported using the appropriate evaluation and management code. The device component for CGM is reported using HCPCS codes. Specifically assigned HCPCS codes help to establish credibility for the medical technology used and thereby reduce claim denials.

Coding for Ultrasound Evaluation

Diagnostic ultrasound and associated ultrasound guided procedures performed by endocrinologists are coded in the following manner:

  • CPT 76536 – ultrasound, soft tissues of head and neck (e.g. thyroid, parathyroid, parotid), real time with image documentation
  • CPT 76942 – ultrasonic guidance for needle placement (e.g. biopsy, aspiration, localization device, injection), imaging supervision and interpretation
  • CPT 10022 – fine needle aspiration; with image guidance
  • CPT 60100 – biopsy thyroid, percutaneous core needle

Other Services Covered

  • Bone density studies – usually coverage for this service depends on the insurance carrier, and is dependent on the diagnosis codes and frequency of service.
  • Diabetes education – this is covered by most insurance carriers, but the CPT code they accept for this type of service often varies. You will have to verify the codes accepted by each carrier to avoid denials.
  • Nerve conduction tests – since these are often performed on multiple muscles, they should be billed with multiple units. You should document and bill for all muscles.
  • Radionuclide Therapy/Diagnostics – find out if this is reimbursed and how the payer reimburses. Insurance carriers might deny the medicine, considering it inclusive with therapy/tests.

Use of Modifier when Coding for Endocrinology Procedures

Modifiers are used along with CPT codes to report any modification in a certain service or procedure. Services distinct from other non E/M services performed on the same day, but are considered appropriate under the particular circumstances have to be reported using the modifier 59. However, this code has to be supported with relevant documents showing

  • A different session
  • A different procedure/surgery
  • Site  or organ system

Documentation must also support a separate incision/excision, injury/area of injury, lesion. It is to be remembered that modifier 59 can be used only when there is no other established modifier available to report the procedure. This modifier cannot be used with an E/M service.

Modifier 25 is used to report a distinct or separately identifiable E/M procedure along with a non-E/M service performed by the same physician on the same day of the procedure or other service. To ensure reimbursement, the medically necessary E/M service and the procedure have to be sufficiently documented by the physician or qualified NPP in the patient’s medical record. When using modifiers, it is best to contact individual insurance carriers to find out if they have any limitations in reimbursing claims reporting modifiers.

The modifier -52 has to be used to signify that a particular service or procedure was reduced or not done at the doctor’s discretion. So, this code helps to report reduced services without creating confusion as regards the basic service provided.

Any procedure code can be reported using the modifier 26, which signifies the professional component whenever applicable. The technical component is to be reported using the modifier TC. For instance, the physician providing the interpretation of an ultrasound examination can claim for the professional component using the modifier -26 appended to the ultrasound code. Similarly, the owner of the equipment can use the modifier TC signifying the technical component of the service, usually performed in an IDTF (Independent Diagnostic Testing Facility).

How Medical Coding Companies Can Help

Endocrinology coding is a complex procedure, requiring in-depth knowledge regarding the diagnostic and procedure codes. In addition, familiarity with the reimbursement policies of individual payers is vital. You need to be thorough about where the service was provided, by whom it was provided, why it was provided and what service was provided before starting to code for a particular procedure. This can be quite tedious for busy medical practitioners and practices. You might often end up without getting paid for all your services. Moreover, you have to be cautious against fraudulent coding practices such as overcoding, undercoding, jamming, unbundling and upcoding. Your best option is to approach a reliable medical coding company which offers the services of certified coders knowledgeable in CPT, ICD-9-CM, ICD-10 and HCPCS coding practices. With accurate and timely coding and billing services, such a company ensures that you get paid for your services.