ICD-9 Coding Corner: Gitelman's Syndrome Code Confusion

Your physician sees a patient with a rare endocrine disorder -- Gitelman's syndrome -- and leaves you to find the appropriate diagnosis code. Finding the correct diagnosis code for this rare and little-known condition can seem daunting, but you can simplify your search by learning about closely associated diagnoses and when they apply to your claims.

"I spent hours researching [this condition] only to become more confused than when I started," one endocrinology coder laments. If your practice can share similar war stories, our experts have advice for you.
Locate the 255.1 Code Block
The search for the right Gitelman's syndrome code begins with 255.1x (Hyperaldosteronism). You'll find various types of aldosteronism, a condition defined by oversecretion of the hormone aldosterone, in 255.1's subsets. Primary aldosteronism (255.10) occurs when the adrenal gland produces excess aldosterone, says Anthony Azzi, MD, clinical endocrinologist with Raleigh Endocrine Associates in Raleigh, N.C. If the physician indicates that the patient has aldosteronism, but does not know the cause, you should report 255.10 because it is the more general code, he says.
Fine Tune the Diagnosis
Primary: Some forms of primary aldosteronism respond to treatment with hydrocortisone, and if the physician diagnoses this separate condition, you should report 255.11 (Glucocorticoid-remediable aldosteronism), Azzi says. The patient may also have "an aldosterone-producing adrenal adenoma" that causes the primary aldosteronism. Physicians refer to this condition as Conn's syndrome (255.12), he adds.
Secondary: If another distinct condition causes the patient's aldosteronism, the physician will diagnose secondary aldosteronism. Bartter's syndrome (255.13) is a form of secondary aldosteronism caused by an abnormality in the kidney that triggers changes in the aldosterone system, Azzi says. But an adrenal problem does not cause the aldosteronism, so the condition is considered secondary. "Gitelman's syndrome may occur in adults as well as children," and is similar to Bartter's syndrome in that it affects another area of the kidney, he says.
Final verdict: Since Gitelman's syndrome is closely related to Bartter's syndrome -- and both are secondary aldosteronism -- your best bet is to assign 255.14 (Other secondary aldosteronism) for a diagnosis of Gitelman's syndrome.

- Published on 2004-07-21