Radiology Coding Alert

You’ll need to know the type to choose the proper code.

Your Cushing’s code choice will multiply by six next year when ICD-10 is implemented. The new diagnosis code set separates your choices based on what’s causing the hormone disorder.

The diagnosis: Cushing’s is a condition caused by exposure to excess cortisol. The cause may be internal, such as a pituitary or adrenal tumor, or external, such as taking corticosteroid medication. Once a Cushing’s diagnosis is established, a physician may order imaging to better understand the cause. Additionally, many payers include Cushing’s as a supporting diagnosis for bone mass measurement.

ICD-9-CM Code:

• 255.0, Cushing’s syndrome

ICD-10-CM Codes:

• E24.0, Pituitary-dependent Cushing’s disease
• E24.2, Drug-induced Cushing’s syndrome
• E24.3, Ectopic ACTH syndrome
• E24.4, Alcohol-induced pseudo-Cushing’s syndrome
• E24.8, Other Cushing’s syndrome
• E24.9, Cushing’s syndrome, unspecified

ICD-9-CM coding rules: ICD-9 includes a single code to encompass multiple types of Cushing’s. The ICD-9 notes show that 255.0 includes the following:

• Adrenal hyperplasia due to excess ACTH

       Cushing’s syndrome: NOS, iatrogenic, idiopathic, pituitary-dependent

• Ectopic ACTH syndrome
• Iatrogenic syndrome of excess cortisol
• Overproduction of cortisol.

The next to last bullet specifies “iatrogenic syndrome.” Iatrogenic relates to a syndrome caused by medical treatment. If the Cushing’s is drug-induced, ICD-9 instructs you to report an additional E code to identify the cause.

Note that if a patient has congenital adrenal hyperplasia, you should report 255.2 (Adrenogenital disorders), not 255.0.

ICD-10-CM changes: ICD-10 will expand your Cushing’s options from one code to six codes, as shown above. The six ICD-10 codes are similar to the list of diagnoses included under ICD-9’s 255.0. The ICD-10 code instructions are also comparable to ICD-9. For drug-induced Cushing’s (E24.2), ICD-10 instructs you to “Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5).” You’re also instructed to look elsewhere to code congenital adrenal hyperplasia (use E25.0, Congenital adrenogenital disorders associated with enzyme deficiency).

Documentation: To help you choose the most specific code, the documentation should show the cause of the Cushing’s. If the record doesn’t show pituitary-dependent, drug-induced, ectopic ACTH (by non-pituitary tumor), alcohol-induced, or another specific type, you’ll have to use unspecified code E24.9.

Coder tips: You should report E24.0 if the record shows overproduction of pituitary ACTH or pituitary-dependent hypercorticalism, according to notes with that code.

Remember: ICD-9 codes will no longer be accepted for dates of service on or after October 1, 2014. “ICD-10 codes will not be recognized or accepted on claims prior to October 1, 2014. Claims cannot contain both ICD-9 codes and ICD-10 codes,” explained Sarah Shirey-Losso from the Provider Billing Group of the Center for Medicare in the “Begin Transitioning to ICD-10 in 2013” National Provider Call on April 18, 2013. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.