Otolaryngology Coding Alert

Question: After a series of blood tests shows a patient has an elevated calcium level due to the parathyroid glands secreting abnormally high hormone amounts, an otolaryngologist diagnoses the patient with hyperparathyroidism. Which ICD-9 code should I use?

Louisiana Subscriber Answer: You should report the patient's primary hyperparathyroidism with 252.01 (Disorders of parathyroid gland; primary hyperparathyroidism). Your question is timely because ICD-9 2005 recently changed the way you code hyperparathyroidism.

Old way: You could previously assign 252.0 for hyperparathyroidism. But starting Oct. 1, insurers will reject this code as lacking a fifth digit.

New way: When submitting a diagnosis of hyperparathyroidism, you'll need to use a fifth digit to indicate whether the patient's hyperparathyroidism is primary, secondary, tertiary or unspecified. You should code the hyperparathyroidism type as follows:

1. If the patient's parathyroid gland activity causes the condition, you should assign primary hyperparathyroidism with 252.01.

2. When another non-renal condition, such as vitamin D deficiency, causes the high calcium levels, submit secondary hyperparathyroidism as 252.02 (... secondary hyperparathyroidism, non-renal).

3. Patients who have long-standing secondary hyperparathyroidism may develop tertiary hyperparathyroidism, which you should report with a fifth digit of "8" (252.08, ... other hyperparathyroidism).

4. If your otolaryngologist doesn't specify the patient's hyperparathyroidism type, assign unspecified code 252.00 (... hyperparathyroidism, unspecified).

Warning: Be careful using 252.00. Because the code is an unspecified code, the insurer may delay processing the claim until you submit further information, meaning a specified code.