Coding of Endocrine, Nutritional, and Metabolic Diseases

The recently implemented 2018 ICD-10 code changes have had far-reaching effects.  As part of our continuing series on these updates, this blog will cover Chapter 4 of ICD-10 coding (codes E00-E89) changes and how they impact endocrine, nutritional and metabolic diseases.

New Codes


 Amyloidosis is a rare disease that occurs when an abnormal protein called amyloid builds up in your organs.  Amyloid is produced in your bone marrow and can be deposited in any tissue or organ.  Amyloidosis can affect different organs in different people, but it frequently attacks the heart, kidneys, liver, spleen, nervous system and digestive tract.  Severe amyloidosis can lead to life-threatening organ failure. There are many different types of Amyloidosis and some of the new ICD-10 codes affect specific diagnoses.

There are three new codes for Amyloidosis, along with the expansion of E85.8 other amyloidosis as detailed below:

  • E85.8 Other amyloidosis
  • E85.81 Light chain (AL) amyloidosis – is the most common type and can affect your heart, kidneys, skin, nerves and liver. Previously known as primary amyloidosis.
  • E85.82 Wild-type transthyretin-related (ATTR) amyloidosis – Hereditary amyloidosis (familial amyloidosis) is an inherited disorder that often affects the liver, nerves, heart and kidneys.
  • E85.89 Other amyloidosis

Diabetes Mellitus (DM)

In the 2018 ICD-10 coding changes there are two new codes for DM, expanding the E11.1 code and dealing further with ketoacidosis.  Ketoacidosis is a buildup of acids in your blood, and it can happen when your blood sugar is too high for too long.  It is rare in Type 2 DM; therefore, if it is documented in a Type 2 DM you should verify it with the physician.  If it is used in home health care it is most likely only in M1011 and/or in M1017.

The new codes include:

  • 1 Type 2 DM with ketoacidosis
  • 10 Type 2 DM with ketoacidosis without coma
  • 11 Type 2 DM with ketoacidosis with coma

Related to DM, is the 2018 Insulin Guideline.  Accordingly, an additional code should be assigned from category Z79 to identify the long-term (current) use of insulin or oral hypoglycemic drugs.  If the patient is treated with both oral medications and insulin, only the code for long-term (current) use of insulin should be assigned.  Code Z79.4 should not be assigned if insulin is given temporarily to bring a type 2 patient’s blood sugar under control during an encounter or for a Type 1 DM.

NEC Manifestations

In the provider documentation there must be links with the conditions in order to code the NEC manifestations (please see those related below).  Any code for intraoperative or post procedure complications must be documented as related to each other in order to code.  Always check the instruction at the beginning of your numeric code to be sure you have the needed documentation for the following.

  • Arthropathy NEC
  • Circulatory complication NEC
  • Complication, specified NEC
  • Kidney complications NEC
  • Neurologic complication NEC
  • Oral complication NEC
  • Skin complication NEC

So Much More to Explore

Chapter 4 of the ICD-10 codes has incorporated many new updates, and this blog just scratches the surface.  If you would like to learn more about these revisions, and how the 5 Star team can help ensure your staff is up-to-date, please contact us at [email protected] or 866-428-4040.

Coding of Endocrine, Nutritional, and Metabolic Diseases
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