Pediatric Coding Alert

Question: Our pediatrician just saw one of our adolescent patients who adopted a vegan lifestyle two years ago. The pediatrician was worried about the patient’s nutrition and ordered a lab to test for B12 deficiency. What diagnosis code can I use to justify the 82607? And is there an ICD-10 code for veganism?

South Carolina Subscriber

Answer: Perhaps the best code you can use to justify the 82607 (Cyanocobalamin (Vitamin B-12)) test until you have a more specific, or principal, diagnosis is Z78.9 (Other specified health status).

Why? According to ICD-10 guideline I.C.21.c.3, you would use a Z code “when circumstances other than a disease, injury or external cause classifiable to categories A00-Y89 are recorded as ‘diagnoses’ or ‘problems.’” The guidelines go on to elaborate that this happen “when a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition … or to discuss a problem which is in itself not a disease or injury, [or] when some circumstance or problem is present which influences the person’s health status but is not in itself a current illness or injury.”

There is no diagnosis code for veganism for the obvious reason that it is not a medical condition. However, it can lead to B12 deficiency, as your pediatrician suspected when ordering the 86207. If that turns out to be true, and the test provides a definitive diagnosis of vegan anemia, you would use D51.3 (Other dietary vitamin B12 deficiency anemia), as vegan anemia is a synonym listed for the code.

Coding alert: D51.3 is the preferred code if your pediatrician determines that the B12 deficiency is a result of the patient’s vegan diet. This mean you should not use E53.8 (Deficiency of other specified B group vitamins) per the Excludes1 note that accompanies D51.3.