Hypopituitarism – an Overview of the Condition and Applicable ICD-10 Codes

Hypopituitarism – an Overview of the Condition and Applicable ICD-10 Codes

Hypopituitarism is a rare disorder of decreased pituitary hormone secretion wherein the pituitary gland fails to produce normal amounts of one or more hormones. The pituitary gland is a small bean-shaped gland situated on the underside of your brain (behind your nose and between your ears) which secretes hormones that influence nearly every part of your bodily functions. The gland produces eight types of hormones – each of which can affect your body’s routine functions related to growth, controlling metabolism, blood pressure and reproduction. The condition can develop very slowly, over several months or even over several years. Treatment for this condition basically involves hormone correction. Taking the right hormone medications can help effectively control the prominent symptoms associated with the condition. Physicians treating hypopituitarism have to ensure accurate documentation of the patient’s condition and treatment provided. Endocrinology medical billing and coding has become increasingly complex due to the growing number of rules and regulations. Outsourcing medical billing and coding services could help endocrinologists and other physicians ensure accurate and timely claim filing for appropriate reimbursement.

Hypopituitarism occurs when your pituitary gland does not release enough of one or more of any of these hormones such as adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), antidiuretic hormone (ADH), Prolactin, follicle-stimulating hormone (FSH), growth hormone (GH), luteinizing hormone (LH) and Oxytocin. The hormone condition may be the result of inherited disorders, but more often it’s acquired. Tumor of the pituitary gland is one of the common causes associated with the condition. A tumor can compress the optic nerves, causing visual disturbances. Other potential causes include – head injuries, autoimmune inflammation (hypophysitis), stroke, infections of the brain (such as meningitis), sarcoidosis, blood loss during childbirth and radiation treatments. However, in some cases, the exact cause of hypopituitarism may be unknown.

Unlock the Signs and Symptoms

Hypopituitarism is often a progressive condition. The signs and symptoms in most cases develop gradually and may at times be subtle and remain unnoticed for months or even years. The signs and symptoms of this hormonal disorder may vary from one person to another and may depend on which pituitary hormones are deficient and how severe the deficiency is. Common symptoms include –

  • Weight loss or weight gain
  • Sensitivity to cold or difficulty staying warm
  • Fatigue and/or weakness
  • Excessive thirst and urination
  • Decreased sex drive
  • Decreased appetite
  • Stiffness in the joints
  • Short stature in children
  • Infertility
  • Hot flashes, irregular or no periods, loss of pubic hair, and inability to produce milk for breast-feeding in women
  • Headache and dizziness
  • Facial puffiness
  • Decreased facial or body hair in men
  • Anemia

Diagnosing and Treating an Underactive Pituitary Gland

If your physician feels that you have hypopituitarism, he/she will conduct several tests to check the levels of various hormones in your body. Several tests that may be conducted include –

  • Blood tests – to detect deficits in hormones as a result of pituitary failure
  • Stimulation or dynamic testing – to check your body’s secretion of hormones after consuming certain medications that stimulate hormone production
  • Vision tests – to check whether the growth of a pituitary tumor has impaired your sight or visual fields

Once the hormone levels in your body are correctly determined, physicians will check the other parts of your body (target organs) which those hormones normally affect. In some cases, the problem may not be with your pituitary gland, but rather with the target organs. In addition, physicians will also conduct several diagnostic imaging tests such as CT scan or MRI scan to check if a tumor on your pituitary gland is affecting its normal function.

Treatment for this condition may be lifelong. As this condition may generally affect a number of hormones, there is no single course of treatment for this condition. One of the initial treatment modalities will be related to hormones – to bring the hormone levels back to normal. In fact, these hormone dosages are given to match the amounts that the body would normally produce if it didn’t have a pituitary gland problem. Hormone replacement medications may include – Corticosteroids, Levothyroxine (Levoxyl, Synthroid, others), sex hormones (testosterone in men and estrogen or a combination of estrogen and progesterone in women) and growth hormones (also called somatropin). In some cases, if a tumor is causing pituitary problems, surgery to remove the tumor growth may be done in order to restore your hormone production to normal. On the other hand, physicians will recommend radiation therapy as well.

Endocrinologists and other physicians who diagnose, screen and provide treatment procedures for hypopituitarism must carefully document the same using the correct medical codes. Medical billing and coding services provided by reputable medical billing companies can help physicians use the correct codes for their medical billing purposes.

ICD-10 codes for Hypopituitarism

E22 – Hyper function of pituitary gland

  • E22.0 – Acromegaly and pituitary gigantism
  • E22.1 – Hyperprolactinemia
  • E22.2 – Syndrome of inappropriate secretion of antidiuretic hormone
  • E22.8 – Other hyperfunction of pituitary gland
  • E22.9 – Hyperfunction of pituitary gland, unspecified

E23 – Hypo function and other disorders of the pituitary gland

  • E23.0 – Hypopituitarism
  • E23.1 – Drug-induced hypopituitarism
  • E23.2 – Diabetes insipidus
  • E23.3 – Hypothalamic dysfunction, not elsewhere classified
  • E23.6 – Other disorders of pituitary gland
  • E23.7 – Disorder of pituitary gland, unspecified

If the pituitary gland is permanently damaged, proper hormone replacement generally requires life-long treatment. The initial course of hormone replacement therapy may take time to determine the patient’s response and to find the best dose. The endocrinologist will correctly monitor the levels of hormones in your blood to ensure that the patient is getting adequate, but not excessive amount of hormones. Physicians will adjust the dosage of corticosteroids if the patient becomes seriously ill or experiences major physical stress.

In short, patients can expect a normal life span, as long as they regularly consume the correct dose of medications recommended by endocrinologists or other physicians.

Endocrinology medical coding can be complex, as there are several codes associated with the condition. By outsourcing these tasks to a reliable and established medical billing and coding company – that offers the services of AAPC-certified coding specialists, healthcare practices can ensure correct and timely medical billing and claims submission.

ICD-10 Codes for Endocrine Disorders

ICD-10 Codes for Endocrine Disorders

Endocrine DisorderComplete, clear and consistent documentation is crucial for on-time reimbursement. Just as any other specialty, endocrinologists’ reimbursement is based on the documentation in the medical record. Endocrinology medical coding involves assigning the accurate diagnosis and procedure codes to various conditions and treatment procedures. It is crucial to submit the appropriate codes and modifiers for services rendered.

With the updated medical terminology, and more comprehensive classifications of diseases, combination codes for conditions & common symptoms or manifestations and inclusion of trimesters, ICD-10 codes help endocrinologists to clearly document the patient’s condition and specify the service provided.

Appropriate clinical documentation can – improve communication and collaboration between physician and the patient; provide an accurate representation of the severity and complexity of a patient’s illness; improve the quality of patient care; enable referring to the medical record together for problems, assessments, procedures and treatments; support and supplement provider documentation, and help substantiate the level of specificity required within ICD-10.

Common Endocrine Conditions and Their ICD-10 Codes

Adrenal Disorders

To properly code a neoplasm it is necessary to determine from the record if the neoplasm is benign, in situ, malignant, or of uncertain histologic behavior. For multiple neoplasms of the same site that are not contiguous, codes for each site should be assigned. Here are some examples.

  • 01 Malignant neoplasm of cortex of right adrenal gland
  • 10 Malignant neoplasm of medulla of unspecified adrenal gland
  • 12 Malignant neoplasm of medulla of left adrenal gland
  • 91 Malignant neoplasm of unspecified part of right adrenal gland
  • 92 Malignant neoplasm of unspecified part of left adrenal gland
  • 10 Neoplasm of uncertain behavior of unspecified adrenal gland
  • 2 Neoplasm of uncertain behavior of parathyroid gland

Diabetes Mellitus

Using ICD-10 coding system, diabetes mellitus can be classified by type, hyperglycemia or hypoglycemia as well as with or without complications. Documenting the patient presentation allows the coder to capture the necessary information to fully code the patient’s condition. The diabetes mellitus codes are combination codes that include the type, the body system affected and the complication(s) affecting the body system.

  • E08 Diabetes mellitus due to underlying condition
  • 35 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy
  • 36 Diabetes mellitus due to underlying condition with diabetic cataract
  • E09 Drug or chemical induced diabetes mellitus
  • 3 Drug or chemical induced diabetes mellitus with ophthalmic complications
  • 31 Type 2 diabetes mellitus with unspecified diabetic retinopathy
  • 62 Type 2 diabetes mellitus with skin complications
  • 65 Type 2 diabetes mellitus with hyperglycemia
  • 69 Type 2 diabetes mellitus with other specified complication

Obesity

Overweight should be accompanied by documentation of body mass index (BMI). Though any clinician can capture and record a patient’s BMI, the provider is ultimately responsible for the completeness of diagnosis documentation.

  • E65 Localized adiposity
  • 01 Morbid (severe) obesity due to excess calories
  • 1 Drug-induced obesity
  • 2 Morbid (severe) obesity with alveolar hypoventilation

Osteoporosis

Medical records should detail any past history of healed osteoporosis fractures and provide information regarding the encounter type. Cause for the condition should also be clarified (age-related, drug-induced, or post-traumatic). If drug-induced, the specific drug should be listed.

  • 051 Age-related osteoporosis with current pathological fracture, right femur
  • 059 Age-related osteoporosis with current pathological fracture, unspecified femur
  • 061 Age-related osteoporosis with current pathological fracture, right lower leg
  • 07 Age-related osteoporosis with current pathological fracture, ankle and foot
  • 08 Age-related osteoporosis with current pathological fracture, vertebra(e)

Thyroid Disorders

Documentation of thyroid problems should clearly designate the problem as:

  • acute or chronic
  • thyrotoxicosis, thyroiditis, goiter or hypothyroidism
  • presence or absence of a diffuse goiter

ICD-10 codes used to document these disorders include:

  • 2 Iodine-deficiency related (endemic) goiter, unspecified
  • 3 Postinfectious hypothyroidism
  • 0 Thyrotoxicosis with diffuse goiter
  • 4 Thyrotoxicosis factitia
  • 4 Drug-induced thyroiditis
  • 81 Sick-euthyroid syndrome
  • 9 Disorder of thyroid, unspecified

Cushing’s syndrome

Cushing’s syndrome can also be described as pituitary-dependent, drug-induced, alcohol-induced, Nelson’s syndrome, ectopic ACTH syndrome, or other.

  • 0 Pituitary-dependent Cushing’s disease
  • 1 Nelson’s syndrome
  • 2 Drug-induced Cushing’s syndrome
  • 3 Ectopic ACTH syndrome
  • 4 Alcohol-induced pseudo-Cushing’s syndrome

Medical billing and coding companies provide the services of medical coders who are familiar with possible complexities associated with reporting endocrine conditions, diagnosis and treatment. By partnering with reliable firms, endocrinologists do not have to face any more issues due to delayed reimbursement, increased audit requests, changing codes, and unfamiliarity with the reimbursement policies of individual payers.

ICD-10 Codes for Endocrine Disorders

Tips for Endocrinologists to Ensure Proper ICD-10 Coding

EndocrinologistsThe expansion of diagnosis codes with ICD-10 makes the endocrinology medical coding process more complex as this specialty involves a wide array of diagnoses and procedures. Endocrinology providers should have a better knowledge about the endocrine system and much more detailed documentation to choose the most appropriate codes. Specificity is very important when it comes to data quality, medical necessity and reimbursement. Here are some effective tips for endocrinologists to prepare well for ICD-10 coding and avoid claim denials or drop in reimbursement.

Some of the crucial diagnoses in this specialty and their coding are as follows.

Diabetes

In order to select the correct ICD-10 code for diabetes, your documentation should include the following:

  • Identify the type
  • Clarify any cause and relationship with other conditions
  • Specify whether any organ system is affected, any complications, and long-term use of insulin for type II diabetes
  • Details about insulin underdosing or overdosing as a result of an insulin pump malfunction (if it occurred)
  • Underlying condition, drug or chemical responsible for secondary diabetes
  • Distinguish whether diabetes is accompanied by ‘hypo’ or ‘hyper’ glycemia and state if hypoglycemia is or is not causing a coma

The basic ICD-10 codes for diabetes mellitus are as follows:

  • E08: Diabetes mellitus due to underlying condition
  • E09: Drug or chemical induced diabetes mellitus
  • E10: Type 1 diabetes mellitus
  • E11: Type 2 diabetes mellitus
  • E13: Other specified diabetes mellitus

These codes are further elaborated according to the varying characteristics of diabetes mellitus. Some examples are:

  • E08.0: Diabetes mellitus due to underlying condition with hyperosmolarity
  • E08.00: Diabetes mellitus due to underlying condition with hyperosmolarity, without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
  • E08.01: Diabetes mellitus due to underlying condition with hyperosmolarity, with coma
  • E08.1: Diabetes mellitus due to underlying condition with ketoacidosis
  • E08.10: Diabetes mellitus due to underlying condition with ketoacidosis, without coma
  • E08.11: Diabetes mellitus due to underlying condition with ketoacidosis, with coma

Also, you are required to report additional codes to specify any underlying conditions, insulin use, specific stage of chronic kidney disease, exact site of any diabetic ulcer (anatomical location and laterality) and severity, poisoning due to drug or toxin, or specific drug or toxin that causes the adverse effect. This is why detailed documentation with aforementioned components is essential.

Malignant Neoplasm

For coding malignant neoplasm, you should include the following into the documentation such as:

  • Identify the site (for example, cortex, medulla, cerebellum)
  • Specify the morphology (malignant, primary/secondary)
  • Indicate the stage as well as any metastatic site
  • State any related exposure to smoke like second hand smoke
  • Details if the patient presented for treatment related for neoplasm

There is more number of codes for malignant neoplasm in ICD-10, which are:

  • C71.6: Malignant neoplasm of cerebellum
  • C74.00: Malignant neoplasm of cortex of unspecified adrenal gland
  • C74.01: Malignant neoplasm of cortex of right adrenal gland
  • C74.02: Malignant neoplasm of cortex of left adrenal gland
  • C74.10: Malignant neoplasm of medulla of unspecified adrenal gland
  • C74.11: Malignant neoplasm of medulla of right adrenal gland
  • C74.12: Malignant neoplasm of medulla of left adrenal gland
  • C74.90: Malignant neoplasm of unspecified part of unspecified adrenal gland
  • C74.91: Malignant neoplasm of unspecified part of right adrenal gland
  • C74.92: Malignant neoplasm of unspecified part of left adrenal gland

Endocrine and Metabolic Disorders

Your documentation should include the following for correctly coding endocrine and metabolic disorders.

  • State the specific disorder, disease, defect, deficiency or syndrome
  • Identify any underlying condition
  • Specify the significance of any abnormal lab findings
  • Give details on disorders such as being congenital, hereditary, primary, idiopathic, secondary, pseudo and familial if applicable

For metabolic disorders, you should specify the amino acid, carbohydrate, or lipid enzyme deficiency that contributes to the disorder. The ICD-10 codes for endocrine and metabolic disorders are as follows

  • E25.0: Congenital adrenogenital disorders associated with enzyme deficiency
  • E25.8: Other adrenogenital disorders
  • E25.9: Adrenogenital disorder, unspecified
  • E30.0: Delayed puberty
  • E34.3: Short stature due to endocrine disorder
  • E23.0: Hypopituitarism
  • E30.1: Precocious puberty
  • E30.8: Other disorders of puberty

The code E23.0 can be used to report both panhypopituitarism and pituitary dwarfism.

Cushing’s syndrome

Document the specific type and cause of Cushing’s disease for correct coding. Unlike ICD-9 (with a single code for Cushing’s syndrome), ICD-10 has number of codes for this condition.

  • E24.0: Pituitary-dependent Cushing’s disease
  • E24.3: Ectopic ACTH syndrome
  • E24.8: Cushing’s syndrome, other
  • E24.2: Drug-induced Cushing’s syndrome
  • E24.4: Alcohol-induced pseudo-Cushing’s syndrome
  • E24.9: Cushing’s syndrome, unspecified

You should state the specific vitamin and/or mineral to assign correct codes for vitamin/mineral or other nutritional deficiencies. Document any symptoms of premature menopause (flushing, sleeplessness, headache or lack of concentration) since this affects coding. If a patient presents with gout, you should document the cause, episode, location and with or without tophi (in case of chronic gout). ICD-10 provides codes for iodine-deficiency-related goiter. You should document those conditions properly to report them using the correct codes, when applicable.

Endocrinologists may use the electronic health record or EHR system to tackle the increased complexity with ICD-10 to certain extent. If you have already implemented such a system, make sure that your templates are updated for the ICD-10 coding system. In addition to this, endocrinologists should coordinate with their medical billing and coding services, to make sure that a ICD 10 trained Coder is reviewing all codes to ensure proper documentation and correct coding.

Endocrinology Medical Coding

Endocrinology Medical Coding

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.