Addison’s disease (also known as primary adrenal insufficiency or hypoadrenalism) is a rare disorder which occurs when the outer layer of the adrenal glands gets damaged. The adrenal glands are two small glands that produce two essential hormones – cortisol and aldosterone. It is caused by disruptions to the adrenal glands, preventing normal secretions of steroid hormones cortisol and aldosterone. If left untreated, this condition can become more severe medical emergency (called Addisonian crisis) causing symptoms such as high fever, loss of consciousness, mental status changes (confusion, fear, or restlessness) and sudden pain in the lower back, belly, or legs. Treatment for Addison’s disease involves taking medications to replace the insufficient amounts of hormones. As nephrology medical coding is complex and tricky, most physician practices rely on medical coding outsourcing to meet their documentation requirements.
Addison Disease
Addison’s disease is a rare condition that affects 1 in 100,000 people in the United States. It occurs among people of all age groups and can affect both men and women. It is very common among people in the age group of 30-50 years. Addison’s disease is classified into two types – primary adrenal insufficiency and secondary adrenal insufficiency. Generally, most cases of Addison’s disease occur due to autoimmune reaction, where in the body’s immune system attacks and destroys the outer part of the adrenal glands. Some of the other causes include – fungal infections, cancer and abnormal growths (tumors), hemorrhage, amyloidosis, tuberculosis and other genetic defects. On the other hand, secondary adrenal insufficiency is caused when the pituitary gland does not create enough of the hormone ACTH, which tells the outer part of the adrenal glands to produce hormones.

Signs and Symptoms

As the damage to the adrenal glands occurs slowly over time, Addison’s symptoms often occur gradually over several months and may include –

  • Unexplained weight loss
  • Salt craving
  • Nausea, diarrhea or vomiting
  • Muscle or joint weakness
  • Low blood sugar (hypoglycemia)
  • Loss of appetite
  • Irritability
  • Extreme fatigue
  • Depression
  • Darkening of your skin (hyper pigmentation)
  • Pain in your lower back, abdomen or legs
  • Low blood pressure
  • Loss of consciousness

Diagnosis and Treatment

Diagnosis of Addison’s disease may begin with a detailed physician evaluation of your signs and symptoms and previous medical history. Physicians may prescribe some laboratory tests to check for your potassium and sodium levels. They may also conduct certain diagnostic imaging tests like ACTH stimulation test, CT scan, and MRI scan, along with blood test and insulin-induced hypoglycemia test to measure hormone levels and level of damage of the adrenal glands.

Treatment for this condition may depend on the potential causes and based on these causes, physicians may prescribe medications that help regulate the adrenal gland. On the other hand, if your condition remains untreated for a long time and has progressed to a life-threatening emergency condition (called Addisonian crisis), your physician may prescribe medications to treat that specific condition first. Addisonian crisis causes low blood pressure, high potassium in the blood, and low blood sugar levels. Treatment modalities for this condition involve hormone replacement therapy in order to correct the levels of steroid hormones that your body isn’t producing. A combination of glucocorticoids medications that include Oral corticosteroids (like Hydrocortisone (Cortef), prednisone or cortisone acetate) and Corticosteroid injections may be prescribed to control the symptoms and replace missing cortisol. Medications may be increased during times of stress, infection, or injury as some patients may need emergency injections of hydrocortisone during stressful situations.

Addison’s Disease – ICD-10 Codes

For appropriate reimbursement, providers should ensure that the diagnostic codes on insurance billing claims for Addison’s disease accurately reflect their diagnosis.

Endocrinologists who treat Addison’s disease rely on reputable medical billing companies to code the condition accurately. The following ICD-10 codes are relevant with regard to this disease –

  • E27 – Other disorders of adrenal gland
    • E27.0 – Other adrenocortical over activity
    • E27.1 – Primary adrenocortical insufficiency
    • E27.2 – Addisonian crisis
    • E27.3 – Drug-induced adrenocortical insufficiency
  • E27.4 – Other and unspecified adrenocortical insufficiency
    • E27.40 – Unspecified adrenocortical insufficiency
    • E27.49 – Other adrenocortical insufficiency
  • E27.5 – Adrenomedullary hyper function
  • E27.8 – Other specified disorders of adrenal gland
  • E27.9 – Disorder of adrenal gland, unspecified

With correct and timely treatment, many of the symptoms of Addison’s disease can be largely controlled. People suffering from this condition must be fully aware about the potential risk of a sudden worsening of symptoms (called Addisonian crisis) which can happen when the levels of cortisol in your body fall significantly. Therefore, they must learn to better manage the fatigue and other symptoms associated with this condition.