Primary Care Coding Alert

Question: How should I code hyperprolactinemia due to psychological medications? Would 253.7 and/or 790.99 be appropriate? Or does a different ICD-9 code better describe the side effect? Oregon Subscriber Answer: Several classes of medications can cause elevated levels of prolactin in the blood. Although high levels are a normal physiological reaction during lactation, in other cases the symptom is pathological. In certain cases of pituitary tumors, prolactin may also be elevated and cause spontaneous galact-orrhea-amenorrhea syndrome (253.1, Disorders of the pituitary gland and its hypothalamic control; other and unspecified anterior pituitary hyperfunction).

And certain psychological medications, such as phenothiazines that treat serious mental and emotional disorders including schizophrenia and other psychotic disorders, may cause abnormal nipple discharge. Because the medication or treatment caused the unfavorable pituitary response (iatrogenic), you should assign 253.7 (Iatrogenic pituitary disorders) along with E939.1 (Drugs, medicinal and biological substances causing adverse effects in therapeutic use; psychotropic agents; phenothiazine-based tranquilizers). Code 790.99 (Other nonspecific findings on examination of blood; other) would not apply. The diagnosis would perhaps indicate a high level of prolactin, but would not explain the problem that you are treating hyperprolactinemia. Answers to You be the Coder and Reader Questions provided by A. Clinton MacKinney, MD, MS, the American Academy of Family Physician representative to the AMA CPT advisory committee; and Linda Gillette, CPC, CCS-P, coder for Marysville Family Medicine in Marysville, Wash.