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November 29, 2004
Coding
for Vitamin Deficiency
For The Record
Vol. 16 No. 24 Page 35
Vitamin deficiency occurs when a person’s
dietary intake is inadequate or when the absorption or storage mechanism
is impaired. The human body requires many different types of vitamins
to function normally.
Vitamin A
Vitamin A (retinol) is found in fish liver oils, liver, egg yolk,
butter, and cream. The recommended dietary allowance (RDA) for vitamin
A is 900 micrograms. Vitamin A is necessary for normal vision, healthy
skin, and defense against infections. If a patient has vitamin A
deficiency, symptoms may include the following:
• night blindness;
• thickening of skin around hair follicles;
• hardened or scarred cornea (xerophthalmia);
• drying of the whites of the eyes and cornea;
and
• spots on the whites of the eyes.
Vitamin A deficiency is classified to ICD-9-CM category
264. The fourth-digit subcategory will depend on the specific manifestation
associated with the vitamin A deficiency, if any, such as night
blindness or xerophthalmia.
Vitamin D
Vitamin D is found primarily in yeast that has been exposed to ultraviolet
light, fortified milk, fish liver oils, and egg yolk. It is also
produced in the skin by ultraviolet light. The RDA for vitamin D
is 10 micrograms. Vitamin D deficiency can be caused by poor nutrition
and lack of exposure to the sun. When a patient develops vitamin
D deficiency, the calcium and phosphate levels in the blood decrease,
which results in bone disease called rickets (268.0) in children
and osteomalacia (268.2) in adults. If a patient with vitamin D
deficiency does not have either rickets or osteomalacia, assign
code 268.9. Symptoms of vitamin D deficiency may include muscle
spasms (tetany), abnormal bone growth, or restlessness.
Vitamin E
Vitamin E is found in vegetable oil, wheat germ, leafy vegetables,
egg yolks, and margarine. The RDA is 10 milligrams. If a patient
is deficient in vitamin E, he or she may experience nerve damage,
retinopathy, and bleeding in the brain in premature infants or intestinal
malabsorption in older children. Other symptoms may include muscle
weakness, loss of balance, loss of reflexes, and ataxia. Vitamin
E deficiency is classified to code 269.1.
Vitamin K
Vitamin K (RDA = 65 micrograms) is found in leafy vegetables, pork,
liver, and vegetable oils. Bacteria in the intestine also produce
it. Vitamin K is necessary for the normal clotting of blood. Symptoms
of vitamin K deficiency may include bleeding into the skin, from
the nose, from a wound, or in the stomach. A patient may also have
blood in the urine or stool. Assign code 269.0 for vitamin K deficiency
or code 776.0 for vitamin K deficiency in newborns.
Vitamin B1
Food sources for vitamin B1 (thiamine) include yeast, pork, liver,
legumes, nuts, potatoes, and whole grain cereals. The RDA for vitamin
B1 is 1.2 milligrams. Patients with vitamin B1 deficiency may experience
nerve, brain, or heart abnormalities. Vitamin B1 deficiency is classified
to code 265.1. However, if it is documented as beriberi, assign
code 265.0.
Vitamin B2 (Riboflavin)
Vitamin B2 (RDA = 1.5 milligrams) is found in milk, cheese, liver,
meat, fish, poultry, eggs, and enriched cereal products. A patient
with vitamin B2 deficiency (266.0), which may be documented as ariboflavinosis,
may experience cracks and scaling lips and corners of mouth or dermatitis.
Niacin
With an RDA of 16 milligrams, niacin is found primarily in yeast,
liver, meat, fish, legumes, and whole grain cereals. A patient deficient
in niacin is also termed pellagra and is classified to code 265.2.
Common symptoms of pellagra may include abnormalities of skin, gastrointestinal
tract, and brain.
Vitamin B6
Food sources for vitamin B6 (pyridoxine) include yeast, liver, organ
meats, whole grain cereals, fish, and legumes. The RDA for vitamin
B6 is 2 milligrams. The symptoms of vitamin B6 deficiency (266.1)
may include convulsions in infants, and anemia, neuropathy, dermatitis,
and confusion in adults.
Biotin
Biotin is a B vitamin necessary for the metabolism of fats and carbohydrates
and has an RDA of 60 micrograms. It is found in liver, kidneys,
egg yolks, fish, nuts, yeast, and cauliflower. Symptoms of biotin
deficiency (266.2) may include sleepiness, weight loss, dermatitis,
anxiety, and muscle pain.
Vitamin B12 (Cobalamin)
Vitamin B12 (RDA = 2 micrograms) is found only in animal products
such as liver, beef, pork, organ meats, eggs, and milk. Therefore,
strict vegetarians are at higher risk of developing vitamin B12
deficiency since their diet eliminates the consumption of animal
products. Patients with vitamin B12 deficiency (266.2) may develop
pernicious anemia.
Folic Acid
Folic acid (folate) is found primarily in fresh leafy green vegetables,
fruits, liver and other organ meats, and yeast. The RDA of folic
acid is 200 micrograms. Symptoms of folic acid deficiency (266.2)
may include pancytopenia or large red blood cells.
Pantothenic Acid
With an RDA of 6 milligrams, pantothenic acid can be found in liver,
yeast, and vegetables. The symptoms of pantothenic acid deficiency
(266.2) may include neurologic disease or burning feet.
Vitamin C
Food sources for vitamin C (ascorbic acid) include citrus fruits,
tomatoes, potatoes, cabbage, and green peppers. The RDA for vitamin
C is 60 milligrams. Vitamin C deficiency is also called scurvy,
which is characterized by bleeding, loose teeth, and inflammation
of the gums. Scurvy is classified to code 267.
Coding and sequencing for vitamin deficiency are
dependent upon 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, and Vicki Sippel, RHIA, of 3M Health Information Systems
(800-367-2447), a leading supplier of coding and classification
systems to nearly 4,000 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.
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