ICD-10 Coding for Macroprolactinoma(D35.2)
Complete ICD-10-CM coding and documentation guide for Macroprolactinoma. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Macroprolactinoma
D35-D36Primary Range
Benign neoplasms
This range includes benign neoplasms of various organs, including the pituitary gland, which is relevant for macroprolactinoma.
Key Information: ICD-10 code for macroprolactinoma
Essential facts and insights about Macroprolactinoma
Primary ICD-10-CM Code for macroprolactinoma
Decision Criteria
clinical Criteria
- MRI shows pituitary tumor >10mm
- Serum prolactin level >250 ng/mL
Applicable To
- Pituitary adenoma
- Macroprolactinoma
Excludes
- Malignant neoplasm of pituitary gland (C75.1)
Clinical Validation Requirements
- MRI showing pituitary tumor >10mm
- Serum prolactin level >250 ng/mL
Code-Specific Risks
- Incorrect sequencing with hyperprolactinemia
- Omission of tumor size in documentation
Coding Notes
- Ensure MRI and prolactin levels are documented to support the diagnosis.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Hyperprolactinemia
E22.1Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Macroprolactinoma to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code D35.2.
Impact
Clinical: Misdiagnosis risk between macro and microadenoma., Regulatory: Non-compliance with documentation standards., Financial: Potential denial of claims due to insufficient documentation.
Mitigation Strategy
Standardize documentation templates to include tumor size., Regular training on documentation requirements.
Impact
Reimbursement: Incorrect DRG assignment affecting reimbursement., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Always sequence D35.2 before E22.1 when both are present.
Impact
Failure to sequence D35.2 before E22.1 can lead to audit flags.
Mitigation Strategy
Implement coding audits and training sessions.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Macroprolactinoma, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Macroprolactinoma
Use these documentation templates to ensure complete and accurate documentation for Macroprolactinoma. These templates include all required elements for proper coding and billing.
Initial diagnosis of macroprolactinoma
Specialty: EndocrinologyRequired Elements
- Tumor size
- Prolactin level
- Symptoms
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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