ICD-10 Coding for Prolactinoma(D35.2, E22.1)
Complete ICD-10-CM coding and documentation guide for Prolactinoma. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Prolactinoma
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| D35.2 | Benign neoplasm of pituitary gland | Use when a benign tumor of the pituitary gland is confirmed by imaging. |
|
| E22.1 | Hyperprolactinemia | Use when elevated prolactin levels are documented and associated with a pituitary tumor. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: What is the ICD-10 code for prolactinoma?
Essential facts and insights about Prolactinoma
Primary ICD-10-CM Codes for prolactinoma
Decision Criteria
clinical Criteria
- Presence of pituitary tumor on imaging
documentation Criteria
- Prolactin level >200 µg/L
Applicable To
- Pituitary adenoma
- Prolactinoma
Excludes
- Malignant neoplasm of pituitary gland (C75.1)
Clinical Validation Requirements
- MRI or CT imaging confirming pituitary tumor
- Prolactin levels >200 µg/L
Code-Specific Risks
- Misclassification with other pituitary tumors
- Omitting documentation of tumor size
Coding Notes
- Ensure imaging and prolactin levels are documented to support diagnosis.
E22.1 - Hyperprolactinemia
Use when elevated prolactin levels are documented and associated with a pituitary tumor.
Applicable To
- Elevated prolactin levels
Excludes
- Drug-induced hyperprolactinemia (E22.0)
Clinical Validation Requirements
- Serum prolactin level >200 µg/L
- Symptoms of hormone excess such as galactorrhea
Coding Notes
Ensure prolactin levels and symptoms are documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Hyperprolactinemia
E22.1Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Prolactinoma to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code D35.2.
Impact
Clinical: Inadequate assessment of tumor impact., Regulatory: Non-compliance with documentation standards., Financial: Potential for incorrect DRG assignment.
Mitigation Strategy
Use templates prompting for tumor size., Educate staff on documentation standards.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Always pair E22.1 with D35.2 when a tumor is confirmed.
Impact
Missing prolactin levels or imaging results.
Mitigation Strategy
Implement documentation checklists.
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 Prolactinoma, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Prolactinoma
Use these documentation templates to ensure complete and accurate documentation for Prolactinoma. These templates include all required elements for proper coding and billing.
Prolactinoma diagnosis and management
Specialty: EndocrinologyRequired Elements
- Tumor size
- Prolactin levels
- Symptoms
- Treatment response
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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