ICD-10 Coding for Prolactinemia(E22.1, T43.595A)
Complete ICD-10-CM coding and documentation guide for Prolactinemia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Prolactinemia
E22.0-E23.7Primary Range
Disorders of pituitary gland
This range includes hyperprolactinemia and related pituitary disorders.
Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances
Used for drug-induced hyperprolactinemia to specify the causative agent.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| E22.1 | Hyperprolactinemia | Use for idiopathic or pituitary-related hyperprolactinemia. |
|
| T43.595A | Adverse effect of antipsychotics | Use for drug-induced hyperprolactinemia due to antipsychotics. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for hyperprolactinemia
Essential facts and insights about Prolactinemia
Primary ICD-10-CM Codes for prolactinemia
Decision Criteria
clinical Criteria
- Prolactin level > 200 ng/mL with macroprolactin excluded
Applicable To
- Idiopathic hyperprolactinemia
- Pituitary-related hyperprolactinemia
Excludes
- Drug-induced hyperprolactinemia (use additional code to identify drug)
Clinical Validation Requirements
- Prolactin level > 200 ng/mL
- Macroprolactin excluded
- MRI pituitary confirms adenoma
Code-Specific Risks
- Using E22.1 without specifying the cause can lead to claim denials.
Coding Notes
- Ensure documentation supports the use of E22.1 with appropriate clinical findings.
T43.595A - Adverse effect of antipsychotics
Use for drug-induced hyperprolactinemia due to antipsychotics.
Clinical Validation Requirements
- Documented use of antipsychotics
- Prolactin level elevation
Coding Notes
Ensure the adverse effect is clearly linked to the medication.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Congenital hypothyroidism
E03.1Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Prolactinemia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E22.1.
Impact
Clinical: May lead to misdiagnosis., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Always document macroprolactin testing results.
Impact
Reimbursement: May lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate representation of patient's condition.
Mitigation Strategy
Add a T-code for the causative agent.
Impact
Lack of specific prolactin level documentation can trigger audits.
Mitigation Strategy
Ensure all prolactin levels are documented with macroprolactin status.
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 Prolactinemia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Prolactinemia
Use these documentation templates to ensure complete and accurate documentation for Prolactinemia. These templates include all required elements for proper coding and billing.
Endocrinology Progress Note
Specialty: EndocrinologyRequired Elements
- Prolactin level
- Macroprolactin exclusion
- MRI findings
- Medication review
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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