ICD-9 Coding Corner: Be Sure to Distinguish Between Hyper- and Hypoparathyroidism

Apply the wrong diagnosis code, and you may say goodbye to reimbursement
Your physician sees a patient with a thyroid condition and writes either "hyperparathyroidism" or "hypoparathy-roidism" on the chart. The problem is, you can't read his writing well enough to determine which diagnosis the patient has. Because he normally sees more patients with hyperparathyroidism than hypo-, you code the visit with 252.0 and submit the claim.

No problem, right? Wrong. That fourth digit may have just cost you your reimbursement.
Although hypo- and hyperparathyroidism may sound similar, your physician, your patient and your insurer view them very differently. Not only can you mistakenly label a patient with a condition she does not have if you assign the wrong diagnosis code, but you can also stop your practice from collecting its rightful reimbursement. Because insurers cover certain procedures for one thyroid condition and not the other, your payment may hinge on accurate ICD-9 coding.
With this new column, we aim to advise endocrinology practices on the best ways to avoid ICD-9 coding errors, focusing on a different aspect of diagnosis coding each month.
ICD-9 lists several codes for hyperparathyroidism and hypoparathyroidism. Our experts explain the differences between these diagnoses and how to apply each correctly.
Select Either Primary or Secondary Hyperparathyroidism
Hyperparathyroidism is the most common parathyroid disorder that endocrinologists treat, says Anthony Azzi, MD, clinical endocrinologist with Raleigh Endocrine Associates in Raleigh, N.C. This disorder includes two main types: primary and secondary hyperparathyroidism.

Primary: Patients with primary hyperparathyroidism (252.0) exhibit a high calcium level, usually due to a parathyroid tumor that produces too much parathyroid hormone, Azzi says. Typically, an endocrinologist will treat this condition by recommending surgery to remove the offending gland, he adds.
Secondary: In contrast, a patient with secondary hyperparathyroidism (588.8, Other specified disorders resulting from impaired renal function, secondary hyperparathyroidism [of renal origin]) exhibits calcium levels that are too low, caused by kidney failure that decreases the body's vitamin D production. The parathyroid glands, which control calcium levels, begin to produce excess parathyroid hormone in an attempt to increase calcium in the body, Azzi says. An endocrinologist will generally treat secondary hyperparathy-roidism by prescribing vitamin D and calcium supplements for the patient.
Easy to tell: The physician's documentation should state either "primary" or "secondary" hyperparathy-roidism. If not, you can easily tell based on whether the patient's calcium levels are too low or too high.

"Most of the patients we see have primary hyperparathy-roidism," not secondary, says Anita Carr, CPC, business office manager and assistant practice manager of Endocrine and Diabetes Associates in Louisville, Ky. To distinguish between the two types, determine whether the physician documented the basic [...]

- Published on 2004-06-21