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November 13, 2006

Coding for Pituitary Gland Disorders
For The Record
Vol. 18 No. 23 P. 39

The pituitary gland is a pea-sized gland located at the base of the brain. Also known as the master gland, the pituitary gland produces several hormones that affect specific parts of the body and also controls the function of other endocrine glands. If the pituitary gland secretes too much or too little of one or more of its hormones, it may result in a variety of disorders.

Hypopituitarism
One common pituitary gland disorder is hypopituitarism, an underactive pituitary gland that may occur when the pituitary fails to produce one or more of the hormones or does not produce enough of one hormone.

The specific symptoms caused by hypopituitarism depend on which pituitary hormones are affected. The following are some common signs and symptoms of hypopituitarism that usually begin gradually and may not be recognized for months or even years as being a problem:

• fatigue;

• decreased energy;

• muscle weakness;

• nausea;

• constipation;

• weight loss or gain;

• decreased appetite;

• abdominal discomfort;

• sensitivity to cold or difficulty staying warm;

• visual disturbances;

• loss of pubic hair or hair in the armpits;

• polydipsia;

• polyuria;

• hypotension; and

• headaches.

To diagnose hypopituitarism, the physician may order blood tests to check hormone levels, a computed tomography scan or magnetic resonance imaging scan to detect a tumor, or vision tests to detect whether a tumor is affecting the patient’s eyesight.

Hypopituitarism is assigned to AHA Coding Clinic for ICD-9-CM code 253.2. The following types of hypopituitarism are assigned to AHA Coding Clinic for ICD-9-CM code 253.7:

• hormone-induced hypopituitarism;

• hypophysectomy-induced hypopituitarism;

• postablative hypopituitarism; and

• radiation-induced hypopituitarism.

Acromegaly
Acromegaly (253.0) is an oversecretion of the pituitary growth hormone causing excessive growth during adulthood. If this condition occurs in children, it is called gigantism. Acromegaly is usually caused by a benign pituitary tumor, called adenoma (227.3). The signs and symptoms involve enlarged hands and feet.

Galactorrhea
Galactorrhea (611.6) is the production of breast milk in men or in women who are not currently breast-feeding. It is most commonly caused by a prolactin-producing tumor called prolactinoma (227.3) in the pituitary gland. Galactorrhea is not a specific disease but a sign associated with the underlying condition.

Diabetes Insipidus
Diabetes insipidus (253.5) results from decreased production of an antidiuretic hormone which is secreted by the posterior lobe of the pituitary gland. Since the body can’t regulate how it handles fluids, diabetes insipidus causes excessive thirst and excessive urine production. If the condition is documented as nephrogenic diabetes insipidus, code 588.1 is assigned instead of code 253.5.

Coding and sequencing for pituitary gland disorders are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to nearly 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payors as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.

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