ICD-10 Coding for Dysmetabolic Syndrome(E88.810)
Complete ICD-10-CM coding and documentation guide for Dysmetabolic Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Dysmetabolic Syndrome
E88.810-E88.819Primary Range
Codes for metabolic syndrome and insulin resistance
This range includes specific codes for metabolic syndrome and various forms of insulin resistance, crucial for accurate diagnosis and billing.
Key Information: ICD-10 code for dysmetabolic syndrome
Essential facts and insights about Dysmetabolic Syndrome
Primary ICD-10-CM Code for dysmetabolic syndrome
Decision Criteria
clinical Criteria
- Patient meets at least three IDF criteria for metabolic syndrome.
coding Criteria
- Use E88.810 as primary when metabolic syndrome is the focus of care.
documentation Criteria
- Document specific values for each criterion met.
Applicable To
- Dysmetabolic syndrome X
- Insulin resistance syndrome
Excludes
- Type 2 diabetes mellitus (E11.-)
Clinical Validation Requirements
- Waist circumference >102 cm (M), >88 cm (F)
- Triglycerides ≥150 mg/dL
- HDL <40 mg/dL (M) or <50 mg/dL (F)
- BP ≥130/85 mmHg
- Fasting glucose ≥100 mg/dL
Code-Specific Risks
- Incorrectly coding unspecified insulin resistance when specific criteria are met.
Coding Notes
- Ensure all criteria are documented to support the use of E88.810.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Dysmetabolic Syndrome to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E88.810.
Impact
Clinical: May lead to misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential denial of claims due to insufficient documentation.
Mitigation Strategy
Use templates that prompt for specific criteria., Educate providers on documentation standards.
Impact
Reimbursement: May affect CMS reimbursement rates., Compliance: Non-compliance with ICD-10 specificity requirements., Data Quality: Leads to inaccurate health data and analysis.
Mitigation Strategy
Query provider to confirm if patient meets ≥3 IDF criteria for metabolic syndrome.
Impact
Risk of using unspecified codes when specific criteria are met.
Mitigation Strategy
Ensure documentation supports the use of specific codes.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Dysmetabolic Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Dysmetabolic Syndrome
Use these documentation templates to ensure complete and accurate documentation for Dysmetabolic Syndrome. These templates include all required elements for proper coding and billing.
Endocrinology Progress Note
Specialty: EndocrinologyRequired Elements
- Assessment of metabolic syndrome criteria
- Detailed lab results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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