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ICD-10 Coding for Low Vitamin D Levels(E55.9)

Complete ICD-10-CM coding and documentation guide for Low Vitamin D Levels. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Vitamin D DeficiencyHypovitaminosis D

Related ICD-10 Code Ranges

Complete code families applicable to Low Vitamin D Levels

E55-E64Primary Range

Nutritional deficiencies

This range includes codes for various nutritional deficiencies, including vitamin D deficiency.

Key Information: ICD-10 code for low vitamin D levels

Essential facts and insights about Low Vitamin D Levels

The ICD-10 code for unspecified vitamin D deficiency is E55.9, used when specific deficiency type is not identified.

Primary ICD-10-CM Code for low vitamin disorder level

Vitamin D deficiency, unspecified
Billable Code

Decision Criteria

clinical Criteria

  • 25(OH)D level <20 ng/mL with symptoms

documentation Criteria

  • Documented lab results and symptoms

Applicable To

  • Hypovitaminosis D

Excludes

Clinical Validation Requirements

  • 25(OH)D level <20 ng/mL
  • Presence of symptoms such as fatigue or bone pain

Code-Specific Risks

  • Using without documented lab results
  • Lack of symptom documentation

Coding Notes

  • Ensure lab results and symptoms are documented to support the use of E55.9.

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Long-term (current) use of hormonal contraceptives

Z79.3
Use when documenting long-term vitamin D supplementation.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Rickets, active

E55.0
Use E55.0 when there is evidence of bone deformities and low vitamin D levels.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Low Vitamin D Levels to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E55.9.

Impact

Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims.

Mitigation Strategy

Include specific lab values, Document related symptoms

Impact

Reimbursement: May lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.

Mitigation Strategy

Ensure lab results are documented in the patient's record.

Impact

Lack of documented lab results for vitamin D levels.

Mitigation Strategy

Ensure all lab results are included in the patient's record.

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 Low Vitamin D Levels, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Low Vitamin D Levels

Use these documentation templates to ensure complete and accurate documentation for Low Vitamin D Levels. These templates include all required elements for proper coding and billing.

Primary Care Evaluation

Specialty: Primary Care

Required Elements

  • Patient's vitamin D level
  • Symptoms related to deficiency
  • Treatment plan

Example Documentation

Assessment: Vitamin D deficiency (E55.9) with 25(OH)D level of 14 ng/mL. Plan: Start cholecalciferol 50,000 IU weekly.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Low vitamin D - start supplements
Good Documentation Example
Vitamin D deficiency (25(OH)D 11.4 ng/mL) with muscle weakness - prescribed ergocalciferol 50,000 IU weekly.
Explanation
The good example includes specific lab values and symptoms, providing a clear rationale for treatment.

Need help with ICD-10 coding for Low Vitamin D Levels? Ask your questions below.

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