Documenting Cushing’s Syndrome with ICD-10 Codes

DOCUMENTING CUSHING’S SYNDROME with ICD-10 Codes Learn more about the diagnosis, treatment modalities, and documentation guidelines for Cushing's syndrome.

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Cushing’s syndrome is a hormonal disorder caused by prolonged exposure of the body’s tissues to abnormally high levels of the hormone cortisol. Also called hypercortisolism, this condition may be caused by the overuse of oral corticosteroid medications. It can also occur when the body produces too much cortisol on its own. The condition is relatively rare and mostly affects people (females) in the age group of 20-50 years, who have been regularly consuming steroid medications for a long time. On the other hand, people who are obese and suffer from Type 2 diabetes (along with poorly controlled blood sugar and high blood pressure) can have an increased risk of developing the disorder. The treatment for this hormonal disorder mainly depends on the potential causes of the condition. The treatment focuses on reducing the level of cortisol in the patient’s body thereby effectively controlling the symptoms. For accurate clinical documentation of this disorder, physicians can opt for medical billing outsourcing services.

Before going on to the medical codes for Cushing’s syndrome, let us look at the symptoms of this condition and how it is diagnosed.

Signs and Symptoms The signs and symptoms of Cushing’s syndrome may vary depending on the levels of excess cortisol. Common symptoms include – ❖ Weight gain and fatty tissue deposits (particularly around the midsection and upper back, in the face and between the shoulders) ❖ Thinning, fragile skin that bruises easily ❖ Slow healing of cuts, insect bites and infections ❖ Severe fatigue and muscle weakness ❖ Pink or purple stretch marks (on the skin of the abdomen, thighs, breasts and arms) ❖ New or worsened high blood pressure ❖ Loss of emotional control ❖ Headache ❖ Cognitive difficulties ❖ Acne Women with this hormonal condition may experience thicker/visible body and facial hair and irregular or absent menstrual periods. On the other hand, men suffering from this condition may experience reduced fertility, erectile dysfunction and decreased libido.

How is Hypercortisolism Diagnosed and Documented?

Diagnosing Cushing’s syndrome, (also called hypercortisolism) is very difficult as this condition has many different causes, and certain signs and symptoms are similar to other conditions. The diagnosis is made based on abnormal cortisol levels in the body. As part of the initial diagnosis, the physician will perform a detailed physical examination and review your previous medical history. In addition they may look for symptoms such as rounding of the face (moon face), fatty tissues between the shoulders and neck (buffalo hump), and thin skin with bruises and stretch marks. Several laboratory tests such as – blood tests, urinary free cortisol test, petrosal sinus sampling test and dexamethasone suppression test will be conducted.

Imaging tests such as CT scans or MRI scans will also be performed to produce images of pituitary and adrenal glands to detect abnormalities, such as tumors.

Treatments for this condition may include medications (to reduce cortisol production in the adrenal glands or reduce ACTH production in the pituitary gland) and radiation therapy (if malignant or cancerous tumors are present) and surgery.

Endocrinologists are reimbursed for the treatments provided to their patients. The diagnosis and other tests offered must be reported on the medical claims using the correct medical codes. Medical billing and coding services provided by reputable companies can help physicians use the correct codes for medical billing. The following ICD-10 codes are to be used for Cushing’s syndrome –

E24 - Cushing's syndrome ➢ ➢ ➢ ➢ ➢ ➢ ➢

E24.0 E24.1 E24.2 E24.3 E24.4 E24.8 E24.9

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Pituitary-dependent Cushing's disease Nelson's syndrome Drug-induced Cushing's syndrome Ectopic ACTH syndrome Alcohol-induced pseudo-Cushing's syndrome Other Cushing's syndrome Cushing's syndrome, unspecified

E 24 should not be used for reimbursement purposes, but the multiple codes below it that are more specific are billable and should be reported on the medical claim to indicate a diagnosis for reimbursement.

The sooner the treatment begins the better will be the expected outcomes.

The length of recovery from this condition will mainly depend on the severity of symptoms and specific causes.