Basic ICD-10-CM/PCS Coding 2013 Edition

1. Basic ICD-10-CM/PCS Coding2013 Edition Chapter 7: Endocrine, Nutritional, and Metabolic Diseases (E00–E89)

2. Learning Objectives • Review the chapter’s learning objectives and key terms • At the conclusion of this chapter, what must you know about the coding of endocrine, nutritional and metabolic diseases?

3. ICD-10-CM Chapter 4: Endocrine, Nutritional and Metabolic Diseases Chapter 4 contains the following blocks of codes: E00–E07 Disorders of thyroid gland E08–E13 Diabetes mellitus E15–E16 Other disorders of glucose regulation and pancreatic internal secretion E20–E35 Disorders of other endocrine glands E36 Intraoperative complications of endocrine system

4. ICD-10-CM Chapter 4: Endocrine, Nutritional and Metabolic Diseases Chapter 4 contains the following blocks of codes 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

5. ICD-10-CM Chapter 4: Coding Guidelines Review ICD-10-CM Guidelines for Endocrine, Nutritional and Metabolic Diseases highlighted as CG in the chapter The guidelines appear in Appendix E in the materials that accompany this text and appear on the website as noted in text in chapter 7.

6. ICD-10-CM Chapter 4: Coding Guidelines Guidelines address the coding and reporting of Diabetes mellitus including Type of diabetes Type of diabetes not documented Diabetes and the use of insulin Diabetes in pregnancy and gestational diabetes Complications due to insulin pump malfunction secondary diabetes mellitus Secondary diabetes

7. Disorders of Thyroid Gland The block of codes, E00–E07, contains frequently coded conditions such as hypothyroidism, nontoxic goiter, thyrotoxicosis or hyperthyroidism There are “code first” notes to code poisoning due to drug or toxin and use additional code for adverse effect. For acute thyroiditis, another note reminds the coder to use additional code (B95–B97) to identify the infectious agent

8. ICD-10-CM and Diabetes Diabetes mellitus is a metabolic disease in which the pancreas does not produce insulin normally. Diabetes type 1: usually diagnosed in younger person, no insulin produced, smaller percent of the population have the disease Diabetes type 2: most common type of diabetes, body does not produce enough insulin Other types of diabetes also exist

9. ICD-10-CM and Diabetes ICD-10-CM contains five categories for diabetes mellitus The diabetes codes are combination code include: Type of diabetes (type 1, 2, due to underlying condition or due to drug and chemical) Body system affected Complication affecting that body system

10. ICD-10-CM and Diabetes For type 1 and type 2 diabetes, the codes contain the details about the diabetes and most of the associated complicaitons A few of the diabetes codes require the use of an additional code to identify an associated condition For other types of diabetes, the underlying condition is listed first, followed by the diabetes code

11. ICD-10-CM and Diabetes Each type of diabetes has a category of codes E08, Diabetes mellitus due to underlying condition Code first the underlying condition, such as Cushing’s Syndrome E09, Diabetes or chemical induced diabetes mellitus Code first poisoning to identify drug or toxin Use additional code for adverse effect to identify drug Use additional code to identify any insulin use

12. ICD-10-CM and Diabetes Each type of diabetes has a category of codes E10, Type 1 Diabetes mellitus Includes: brittle diabetes (mellitus) diabetes (mellitus) due to autoimmune process, diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction, idiopathic diabetes (mellitus), juvenile onset diabetes (mellitus) and ketosis-prone diabetes (mellitus) E11, Type 2 Diabetes mellitus Includes: diabetes (mellitus) due to insulin secretory defect, diabetes NOS, insulin resistant diabetes (mellitus) Use additional code to identify any insulin use

13. ICD-10-CM and Diabetes Each type of diabetes has a category of codes E13, Other specified diabetes mellitus Includes: diabetes mellitus due to genetic defects of beta-cell function, diabetes mellitus due to genetic defects in insulin action, postpancreatectomy diabetes mellitus, postprocedural diabetes mellitus, secondary diabetes mellitus NEC Use additional code to identify any insulin use

14. ICD-10-CM and Diabetes Other forms of diabetes are coded elsewhere in ICD-10-CM Gestational diabetes (O24.4-) Neonatal diabetes mellitus (P70.2) ICD-10-CM codes includes one or more complications or manifestations, for example, Diabetic nephropathy Diabetic neuropathy Diabetic retinopathy

15. ICD-10-CM and Diabetes An additional code of Z79.4 is used to identify patients who routinely use insulin for the management of their type 2 or other forms of diabetes Type 1 diabetes patients are typically treated with insulin and therefore the additional code of Z79.4 would not be used with type 1 diabetes

16. Other Disorders of Glucose Regulation Block of codes E15–E16 include nondiabetic hypoglycemic coma and other hypoglycemic conditions Hypoglycemia occurs when the body does not experience a rise in the blood sugar needed after the liver releases glucose that it has stored

17. Disorders of Other Endocrine Glands The endocrine system is made up of endocrine glands that secrete hormones. There are eight major endocrine glands: Pituitary, pineal, thyroid, thymus, adrenal, pancreas, testes, and ovaries.

18. Disorders of Other Endocrine Glands Some of the commonly coded conditions are Cushing’s syndrome, Addison’s disease, polycystic ovarian syndrome, premature menopause, multiple endocrine neoplasiasyndromes, and carcinoid syndrome. For conditions related to the use of medications, notes state “use additional code” for adverse effect to identify drug responsible for the gland’s dysfunction.

19. Malnutrition Malnutrition is the condition that occurs when the body system does not get enough nutrients. Causes of malnutrition include: Inadequate or unbalanced diet Problems with digestion or absorption Certain medical conditions Severe forms of malnutrition Kwashiokor Marasmus

20. Other Nutritional Deficiencies Block of codes from E50–E64 include a variety of vitamin and other nutrient deficiencies. Examples include deficiencies of vitamin A, thiamine, B group, D and K deficiencies. Other conditions include dietary deficiencies of calcium, zinc, iron, magnesium, and other specified nutrient elements Malnutrition and other nutritional deficiencies can produce long term effects

21. Overweight, Obesity and Other Hyperalimentation Category E66, overweight and obesity, includes an instructional note to code first obesity complicating pregnancy if the patient is pregnant Another note states to use an additional code to identify body mass index if known

22. Metabolic Disorders The commonly coded conditions in this block of codes include hypercholesterolemia, hyperlipidemia, cystic fibrosis, dehydration, hyperkalemia, hypokalemia, electrolyte imbalance and metabolic syndrome Volume depletion may refer to depletion of total body water or depletion of the blood volume

23. Metabolic Disorders Dehydration is a lack of adequate water in the body that may be caused by vomiting, excessive heat and sweating, diarrhea or lack of food or fluid intake. Hypovolemia is an abnormally low circulating blood volume. Blood loss may be due to internal bleeding from disease or injury, external bleeding from an injury, or loss of blood volume and body fluid associated with diarrhea, vomiting, dehydration or burns.

24. Metabolic Disorders Cystic fibrosis is an inherited disease of the exocrine glands that affects the gastrointestinal and respiratory systems. It is characterized by chronic obstructive pulmonary disease, pancreatic insufficiency and abnormally high sweat electrolytes. The degree of the pulmonary involvement usually determines the course of the disease.

25. Postprocedural Complications and Disorders NEC Conditions codes to this category include Postprocedural hypothyroidism Hypoinsulinemia Hypoparathyroidism Hypopituitarism Postprocedural ovarian failure Postprocedural hemorrhage and hematoma

26. ICD-10-PCS Coding for Related Procedures The more common procedures on the endocrine glands are excision, resection, and destruction Surgical removal of the adrenal, thyroid, and parathyroid glands are commonly coded procedures Stereotactic radiosurgery using gamma beam, particulate type or other photon radiosurgery is available to destroy lesions on the endocrine glands. These conditions are classified in the radiation oncology section of ICD-10-PCS

27. Exercises Practice coding the conditions included in Chapter 4 of ICD-10-CM including endocrine, nutritional and metabolic diseases as well as the procedures used to treat these conditions by completing the review exercises for Chapter 7