ICD-9 Coding Corner: Understand the Breakdown of Hyperlipidemia

Don't settle for 272.2 or 272.4 too quickly

Endocrinologists often treat patients with hyperlipidemia, and coders often jump the gun and report 272.2 or 272.4 when they could be reporting a more specific code. You should always strive to comply with the cardinal rule of ICD-9 coding - to code to the greatest specificity possible - and hyperlipidemia is no exception.
 
If you understand how the general hyperlipidemia diagnosis breaks down into more specific diagnoses, you'll be ready to sort through the 272 series (Disorders of lipoid metabolism) and select the most appropriate code.
 
Know the four most common codes: Hyperlipidemia is a general term that implies an excess of fatty substances in the blood. A patient with hyperlipidemia can have high cholesterol, high triglycerides, elevated levels of lipoproteins, or some combination of these conditions, says Anthony Azzi, MD, a clinical endocrinologist with Raleigh Endocrine Associates in Raleigh, N.C.
 
272.0: You should report 272.0 (Pure hypercholesterolemia) if your physician indicates the patient has high cholesterol and no other excess lipids. This code is more specific than reporting a general hyperlipidemia code.
 
272.1: Report 272.1 (Pure hyperglyceridemia) when the patient has only high triglycerides. Again, choosing this code will provide greater specificity.
 
272.2: You should report 272.2 (Mixed hyperlipidemia) when the physician diagnoses a patient with hyperlipidemia who has an inherited metabolic disorder causing elevated cholesterol and triglyceride levels. Examples of such diagnoses include dysbeta-lipoproteinemia and familial combined hyperlipidemia, Azzi says.
 
272.4: You can report 272.4 (Other and unspecified hyperlipidemia) anytime the physician simply writes "hyperlipidemia" and does not elaborate on the specifics of the condition.
 
Note: In the interest of correct coding, you should ask your physicians to include adequate information in the patient's chart to allow you to report the most specific code in these cases.
 
You should also report 272.4 when the patient has a combination of high cholesterol and high triglycerides and an inherited metabolic disorder isn't causing the condition. Code 272.4 indicates a type of hyperlipidemia resulting from kidney failure, alcohol abuse, poorly controlled diabetes, obesity and other such conditions.
 
Popular misconception: Many physicians and coders use 272.2 to report patients with acquired hyperlipidemia and 272.4 for the more rare patients whose hereditary metabolic disorder causes the hyperlipidemia.
 
"Very rarely do I use 272.4," says Teresa Herminghuysen, office manager with Endocrine Care & Education Center in Biloxi, Miss. She and her physicians use 272.2 much more frequently because they apply this code to patients with acquired hyperlipidemia that is a combination of both high cholesterol and triglycerides. "And the insurance companies have always paid on my claims," she says.
 
Coding experts agree that carriers will most likely pay on any code from the 272 series because hyperlipidemia is a serious condition in any form. [...]

- Published on 2004-08-26