Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders: (ICD-9-CM Chapter 3, Codes 240-279, and ICD-10-CM Chapter 4, Codes E00-E89)



Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders


(ICD-9-CM Chapter 3, Codes 240-279, and ICD-10-CM Chapter 4, Codes E00-E89)



Learning Objectives



1. Apply and assign the correct ICD-9-CM and ICD-10-CM codes in accordance with Official Guidelines for Coding and Reporting


2. Identify major differences between ICD-9-CM and ICD-10-CM related to the endocrine, nutritional, and metabolic diseases and immunity disorders


3. Identify pertinent anatomy and physiology of the endocrine, nutritional, and metabolic diseases and immunity disorders


4. Identify endocrine, nutritional, and metabolic diseases and immunity disorders


5. Assign the correct V/Z codes and procedure codes related to the endocrine, nutritional, and metabolic diseases and immunity disorders


6. Identify common treatments, medications, laboratory values, and diagnostic tests


7. Explain the importance of documentation in relation to MS-DRGs for reimbursement



Abbreviations/Acronyms































ICD-9-CM Official Guidelines for Coding and Reporting


Please refer to the companion Evolve website for the most current guidelines.




3. Chapter 3: Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders (240-279)



a. Diabetes mellitus


    Codes under category 250, Diabetes mellitus, identify complications/manifestations associated with diabetes mellitus. A fifth-digit is required for all category 250 codes to identify the type of diabetes mellitus and whether the diabetes is controlled or uncontrolled.


    See I.C.3.a.7 for secondary diagnosis.


    



1) Fifth-digits for category 250:


    The following are the fifth-digits for the codes under category 250:


    



The age of a patient is not the sole determining factor, though most type I diabetics develop the condition before reaching puberty. For this reason type I diabetes mellitus is also referred to as juvenile diabetes.



Example


Juvenile diabetes, 250.01 (E10.9).




Example


The patient is a 16-year-old with obesity and diabetes mellitus, type II, uncontrolled, 250.02, 278.00 (E11.65, E66.9).


2) Type of diabetes mellitus not documented


    If the type of diabetes mellitus is not documented in the medical record the default is type II.



Example


The patient takes daily insulin for diabetes, 250.00, V58.67 (E11.9, Z79.4).



3) Diabetes mellitus and the use of insulin


    All type I diabetics must use insulin to replace what their bodies do not produce. However, the use of insulin does not mean that a patient is a type I diabetic. Some patients with type II diabetes mellitus are unable to control their blood sugar through diet and oral medication alone and do require insulin. If the documentation in a medical record does not indicate the type of diabetes but does indicate that the patient uses insulin, the appropriate fifth-digit for type II must be used. For type II patients who routinely use insulin, code V58.67, Long-term (current) use of insulin, should also be assigned to indicate that the patient uses insulin. Code V58.67 should not be assigned if insulin is given temporarily to bring a type II patient’s blood sugar under control during an encounter.



Example


A patient with type II diabetes has been undergoing changes to daily insulin dosages. The patient’s diabetes is uncontrolled, 250.02, V58.67 (E11.65, Z79.4).



4) Assigning and sequencing diabetes codes and associated conditions


    When assigning codes for diabetes and its associated conditions, the code(s) from category 250 must be sequenced before the codes for the associated conditions. The diabetes codes and the secondary codes that correspond to them are paired codes that follow the etiology/manifestation convention of the classification. (See Section I.A.6., Etiology/manifestation convention). Assign as many codes from category 250 as needed to identify all of the associated conditions that the patient has. The corresponding secondary codes are listed under each of the diabetes codes (Figure 12-1).


image
Figure 12-1 Tabular entry for diabetes mellitus.


Example


The patient was admitted for care of a diabetic left midfoot ulcer. The patient also had chronic kidney disease due to type II diabetes, 250.80, 707.14, 250.40, 585.9 (E11.621, L97.429, E11.22).




5) Diabetes mellitus in pregnancy and gestational diabetes



6) Insulin pump malfunction



7) Secondary Diabetes Mellitus


    Codes under category 249, Secondary diabetes mellitus, identify complications/manifestations associated with secondary diabetes mellitus. Secondary diabetes is always caused by another condition or event (e.g., cystic fibrosis, malignant neoplasm of pancreas, pancreatectomy, adverse effect of drug, or poisoning).


    



(a) Fifth-digits for category 249:


    A fifth-digit is required for all category 249 codes to identify whether the diabetes is controlled or uncontrolled.


(b) Secondary diabetes mellitus and the use of insulin


    For patients who routinely use insulin, code V58.67, Long-term (current) use of insulin, should also be assigned. Code V58.67 should not be assigned if insulin is given temporarily to bring a patient’s blood sugar under control during an encounter.


(c) Assigning and sequencing secondary diabetes codes and associated conditions


    When assigning codes for secondary diabetes and its associated conditions (e.g. renal manifestations), the code(s) from category 249 must be sequenced before the codes for the associated conditions. The secondary diabetes codes and the diabetic manifestation codes that correspond to them are paired codes that follow the etiology/manifestation convention of the classification. Assign as many codes from category 249 as needed to identify all of the associated conditions that the patient has. The corresponding codes for the associated conditions are listed under each of the secondary diabetes codes. For example, secondary diabetes with diabetic nephrosis is assigned to code 249.40, followed by 581.81.


(d) Assigning and sequencing secondary diabetes codes and its causes


    The sequencing of the secondary diabetes codes in relationship to codes for the cause of the diabetes is based on the reason for the encounter, applicable ICD-9-CM sequencing conventions, and chapter-specific guidelines.


    If a patient is seen for treatment of the secondary diabetes or one of its associated conditions, a code from category 249 is sequenced as the principal or first-listed diagnosis, with the cause of the secondary diabetes (e.g. cystic fibrosis) sequenced as an additional diagnosis.



Example


Uncontrolled diabetes mellitus due to Cushing’s syndrome. Patient has been on insulin for the last year. 249.01, 255.0, V58.67 (E24.9, E08.65, Z79.4).



    If, however, the patient is seen for the treatment of the condition causing the secondary diabetes (e.g., malignant neoplasm of pancreas), the code for the cause of the secondary diabetes should be sequenced as the principal or first-listed diagnosis followed by a code from category 249.


    



Apply the General Coding Guidelines as found in Chapter 5 and the Procedural Guidelines as found in Chapter 6.



ICD-10-CM Official Guidelines for Coding and Reporting


Please refer to the companion Evolve website for the most current guidelines.




4. Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00-E89)



a. Diabetes mellitus


    The diabetes mellitus codes are combination codes that include the type of diabetes mellitus, the body system affected, and the complications affecting that body system. As many codes within a particular category as are necessary to describe all of the complications of the disease may be used. They should be sequenced based on the reason for a particular encounter. Assign as many codes from categories E08 – E13 as needed to identify all of the associated conditions that the patient has.


    



1) Type of diabetes


    The age of a patient is not the sole determining factor, though most type 1 diabetics develop the condition before reaching puberty. For this reason type 1 diabetes mellitus is also referred to as juvenile diabetes.


2) Type of diabetes mellitus not documented


    If the type of diabetes mellitus is not documented in the medical record the default is E11.-, Type 2 diabetes mellitus.


3) Diabetes mellitus and the use of insulin


    If the documentation in a medical record does not indicate the type of diabetes but does indicate that the patient uses insulin, code E11, Type 2 diabetes mellitus, should be assigned. Code Z79.4, Long-term (current) use of insulin, should also be assigned to indicate that the patient uses insulin. Code Z79.4 should not be assigned if insulin is given temporarily to bring a type 2 patient’s blood sugar under control during an encounter.


4) Diabetes mellitus in pregnancy and gestational diabetes


    See Section I.C.15. Diabetes mellitus in pregnancy.


    See Section I.C.15. Gestational (pregnancy induced) diabetes


5) Complications due to insulin pump malfunction



(a) Underdose of insulin due to insulin pump failure


    An underdose of insulin due to an insulin pump failure should be assigned to a code from subcategory T85.6, Mechanical complication of other specified internal and external prosthetic devices, implants and grafts, that specifies the type of pump malfunction, as the principal or first-listed code, followed by code T38.3×6-, Underdosing of insulin and oral hypoglycemic [antidiabetic] drugs. Additional codes for the type of diabetes mellitus and any associated complications due to the underdosing should also be assigned.


(b) Overdose of insulin due to insulin pump failure


    The principal or first-listed code for an encounter due to an insulin pump malfunction resulting in an overdose of insulin, should also be T85.6-, Mechanical complication of other specified internal and external prosthetic devices, implants and grafts, followed by code T38.3×1-, Poisoning by insulin and oral hypoglycemic [antidiabetic] drugs, accidental (unintentional).


6) Secondary Diabetes Mellitus


    Codes under categories E08, Diabetes mellitus due to underlying condition, and E09, Drug or chemical induced diabetes mellitus, identify complications/manifestations associated with secondary diabetes mellitus. Secondary diabetes is always caused by another condition or event (e.g., cystic fibrosis, malignant neoplasm of pancreas, pancreatectomy, adverse effect of drug, or poisoning).


    



(a) Secondary diabetes mellitus and the use of insulin


    For patients who routinely use insulin, code Z79.4, Long-term (current) use of insulin, should also be assigned. Code Z79.4 should not be assigned if insulin is given temporarily to bring a patient’s blood sugar under control during an encounter.


(b) Assigning and sequencing secondary diabetes codes and its causes


    The sequencing of the secondary diabetes codes in relationship to codes for the cause of the diabetes is based on the Tabular List instructions for categories E08 and E09. For example, for category E08, Diabetes mellitus due to underlying condition, code first the underlying condition; for category E09, Drug or chemical induced diabetes mellitus, code first the drug or chemical (T36-T65).


    



Apply the General Coding Guidelines as found in Chapter 5 and the Procedural Guidelines as found in chapter 7.




Major Differences between ICD-9-CM and ICD-10-CM




image In ICD-10-CM, there are five category codes for diabetes mellitus:



















E08 Diabetes mellitus due to underlying condition
E09 Drug or chemical induced diabetes mellitus
E10 Type I diabetes mellitus
E11 Type II diabetes mellitus
E13 Other specified diabetes mellitus

image In ICD-10-CM, if a condition such as diabetes mellitus is drug-induced, there is an instructional note to use an additional code to identify the drug T36-T50.


image In ICD-9-CM, there are fifth digits to identify whether a patient’s diabetes is controlled, uncontrolled, or unspecified. In ICD-10-CM, there are Alphabetic Index entries for “out of control” and “poorly controlled” diabetes that state to code to diabetes by type, with hyperglycemia.


image In ICD-9-CM there is no specific code to identify hyperglycemia with diabetes. In ICD-10-CM, there are codes to identify both hyperglycemia and hypoglycemia in a diabetic patient.


image Procedural complications affecting the endocrine system and metabolic complications are included in Chapter 4 of ICD-10-CM. Some of the complications include:




Anatomy and Physiology


The endocrine system (Figure 12-2) works with the nervous system to maintain body functions and homeostasis and to respond to stress. The endocrine system is composed of many glands that are located throughout the body. These glands secrete hormones that can regulate bodily functions such as urinary output, cellular metabolic rate, growth, and development.


image
Figure 12-2 The endocrine system.

Major endocrine glands include the following:



See Table 12-1 for a listing of the glands, corresponding hormones, and expected hormonal response.



TABLE 12-1


MAJOR ENDOCRINE GLAND SECRETIONS AND FUNCTIONS1




























































































Endocrine Gland Hormone Target Action
Anterior pituitary Growth hormone (GH) Promotes bone and tissue growth
Thyrotropin (thyroid-stimulating hormone [TSH]) Stimulates thyroid gland and production of thyroxine
Corticotropin (adrenocorticotropic hormone [ACTH]) Stimulates adrenal cortex to produce glucocorticoids
Gonadotropin Initiates growth of eggs in ovaries; stimulates spermatogenesis in testes
Follicle-stimulating hormone (FSH)  
Luteinizing hormone (LH) Causes ovulation; stimulates ovaries to produce estrogen and progesterone; stimulates testosterone production
Prolactin Stimulates breast development and formation of milk during pregnancy and after delivery
Melanocyte-stimulating hormone (MSH) Regulates skin pigmentation
Posterior pituitary Vasopressin (antidiuretic hormone [ADH]) Stimulates water resorption by renal tubules; has antidiuretic effect
Oxytocin Stimulates uterine contractions; stimulates ejection of milk in mammary glands; causes ejection of secretions in male prostate gland
Thyroid Thyroxine (T4) and triiodothyronine (T3)—thyroid hormone (TH) Regulates rate of cellular metabolism (catabolic phase)
Calcitonin Promotes retention of calcium and phosphorus in bone; opposes effect of parathyroid hormone
Parathyroid Parathyroid hormone (parathormone, PTH) Regulates metabolism of calcium; elevates serum calcium levels by drawing calcium from bones
Adrenal cortex Mineralocorticoids (MCs), primarily aldosterone Promote retention of sodium by kidneys; regulate electrolyte and fluid homeostasis
Glucocorticoids (GCs): cortisol, corticosterone, cortisone Regulate metabolism of carbohydrates, proteins, and fats in cells
Gonadocorticoids: androgens, estrogens, progestins Govern secondary sex characteristics and masculinization
Adrenal medulla Catecholamines: epinephrine and norepinephrine Produce quick-acting “fight or flight” response during stress; increase blood pressure, heart rate, and blood glucose level; dilate bronchioles
Pancreas Insulin Regulates metabolism of glucose in body cells; maintains proper blood glucose level
Glucagon Increases concentration of glucose in blood by causing conversion of glycogen to glucose
Ovaries Estrogens Cause development of female secondary sex characteristics
Progesterone Prepares and maintains endometrium for implantation and pregnancy
Testes Testosterone Stimulates and promotes growth of male secondary sex characteristics and is essential for erections
Thymus Thymosin Promotes development of immune cells (gland atrophies during adulthood)
Pineal gland Melatonin Regulates daily patterns of sleep and wakefulness; inhibits hormones that affect ovaries; other functions unknown


image


Endocrine diseases may result from an abnormal decrease or increase in hormone production. Changes in the size of a gland can alter hormone production. If the gland becomes larger, this is called hyperplasia and/or hypertrophy. If the gland becomes smaller, this is called hypoplasia and/or atrophy. Infection, inflammation, radiation, trauma, and surgical procedures can produce changes in the gland and hormonal dysfunction.


Some common mental and physical symptoms include the following:




Disease Conditions


Diseases of the Endocrine, Nutritional and Metabolic Disease, and Immunity Disorders (240-279), Chapter 3 in the ICD-9-CM code book, is divided into the following categories:




















CATEGORY SECTION TITLES
240-246 Disorders of Thyroid Gland
249-259 Diseases of Other Endocrine Glands
260-269 Nutritional Deficiencies
270-279 Other Metabolic and Immunity Disorders

Diseases of the endocrine system and nutritional and metabolic disorders (E00 to E89), covered in Chapter 4 of the ICD-10-CM code book, are divided into the following categories:






































CATEGORY SECTION TITLES
E00-E07 Disorders of the Thyroid Gland
E08-E13 Diabetes Mellitus
E15-E16 Other of Glucose Regulation and Pancreatic Internal Secretion
E20-E35 Disorders of Other Endocrine Glands
E36 Intraoperative Complications of Endocrine System
E40-E46 Malnutrition
E50-E64 Other Nutritional Deficiencies
E65-E68 Overweight, Obesity, and Other Hyperalimentation
E70-E88 Metabolic Disorders
E89 Postprocedural Endocrine and Metabolic Complications and Disorders, Not Elsewhere Classified


Disorders of Thyroid Gland


Goiter


Goiter is an enlargement of the thyroid gland (Figure 12-3). This enlargement may be uniform throughout the gland or diffuse. Enlargement may also occur in the form of nodules or nodular goiter. A goiter can cause difficulties in swallowing and/or breathing and may or may not be associated with hormonal disturbances. The most common cause is lack of iodine in the diet. Goiters due to iodine deficiency are rare in the United States since the introduction of iodized salt.


image
Figure 12-3 Goiter. Note the enlarged neck due to enlargement of the thyroid gland.


Example


Patient has a multinodular goiter, 241.1 (E04.2).



Hypothyroidism


Hypothyroidism is diminished production of thyroid hormone, manifested by low metabolic rate, tendency toward weight gain, somnolence, and sometimes myxedema. Myxedema is a skin and tissue disorder that is usually due to severe, prolonged hypothyroidism (Figure 12-4). Symptoms include dull, puffy, yellowed skin; coarse, sparse hair; and periorbital edema and prominent tongue.


image
Figure 12-4 Myxedema.


Example


Patient has hypothyroidism, 244.9 (E03.9).


Hashimoto’s disease is an inflammation of the thyroid gland that often results in hypothyroidism. It is most common in women and individuals who have a family history of thyroid disease. Onset of Hashimoto’s is slow, and it may not be detected for years. The most common signs and symptoms of Hashimoto’s disease include the following:




Example


Patient has constipation and fatigue due to autoimmune thyroiditis, 245.2, 564.00 (the fatigue code comes from the symptom chapter) (E06.3, K59.00).



Hyperthyroidism/Graves’ Disease


Hyperthyroidism (Figure 12-5) is an abnormality of the thyroid gland in which secretion of thyroid hormone is usually increased and is no longer under the regulatory control of hypothalamic-pituitary centers.


image
Figure 12-5 Comparison of hypothyroidism and hyperthyroidism.

Graves’ disease, the most common form of hyperthyroidism, occurs as the result of an autoimmune response that attacks the thyroid gland, resulting in overproduction of the thyroid hormone thyroxine. Graves’ disease is most common among women between 20 and 40 years of age. The most common signs and symptoms include the following:



Graves’ ophthalmopathy is also fairly common and may result in exophthalmos, or bulging eyes (Figure 12-6). A complication of hyperthyroidism is thyrotoxic crisis or storm. This is a sudden intensification of symptoms combined with fever, rapid pulse, and delirium. Medical attention is required when a crisis episode occurs.


image
Figure 12-6 Exophthalmos in Graves’ disease.

Related posts:

  1. Diseases of the Skin and Subcutaneous Tissue: (ICD-9-CM Chapter 12, Codes 680-709, and ICD-10-CM Chapter 12, Codes L00-L99)
  2. Diseases of the Respiratory System: (ICD-9-CM Chapter 8, Codes 460-519, and ICD-10-CM Chapter 10, Codes J00-J99)
  3. Injuries and E Codes: (ICD-9-CM Chapter 17, Codes 800-995, and External Causes, E800-E999, and ICD-10-CM Chapters 19 and 20, Codes S00-Y99)
  4. Introduction to ICD-10-PCS

Stay updated, free articles. Join our Telegram channel
Tags:
Jun 14, 2017 | Posted by in GENERAL SURGERY | Comments Off on Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders: (ICD-9-CM Chapter 3, Codes 240-279, and ICD-10-CM Chapter 4, Codes E00-E89)

Full access? Get Clinical Tree
Get Clinical Tree app for offline access