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The ICD, also known as the International Statistical Classification of Diseases and Related Health Problems, underlies the global classification and identification of health trends and statistics.
This international classification is required for a specific diagnosis; Therefore, in 1999, the disease morbidity classification was introduced in the United States.
The World Health Organization (WHO) developed the ICD to record medical diagnoses, procedures, services, and patient treatment information.
It was primarily designed for accurate disease tracking within a population. This system was established by the United States Health System for statistical analysis and billing purposes.
Codes only apply to hospital stays, observations greater than 12 hours, and same-day surgeries.
They contain at least one diagnostic code associated with each specific disorder or sign and symptom per hospital visit.
This research focuses on the purpose and history of the ICD 10 CM and its specific low testosterone code.
- 1 Why is CDI important?
- 2 ICD 10 CM history
- 3 Does ICD affect Medicaid benefits and reimbursements?
- 4 CID 10 for low testosterone levels
- 4.1 Testicular hypofunction
- 4.1.1 Testicular hypogonadism
- 4.1.2 Defective testicular androgen biosynthesis in the
- 4.1.3 5-delta reductase deficiency (in male pseudohermaphroditism) (ICD-10-CM E29.1)
- 4.2 Adverse Reactions
- 4.1 Testicular hypofunction
- 5 Applicable previous references
- 6 exceptions for CID 10 CM E29.1
- 7. Conclusion
Why is CDI important?
Although the ICD service was originally designed to screen for various illnesses, its role in documentation and billing is heavily used in American healthcare.
The healthcare industry will benefit most from this new coding system, as several new codes are available for more specific anatomical sites, etiologies, comorbidities, complications, and disease severity.
The additional laterality code, built into the new ICD 10 CM codes, is particularly useful for hospital reimbursement, billing and treatment purposes, as it has separate codes that differentiate right, left and bilateral when necessary.
Using the new ICD 10 CM system would provide better data for tracking health service utilization and quality of patient care.
Other health concepts such as underdosing, blood type, Glasgow coma scale and alcohol levels have also been added.
The various trimesters of pregnancy also have their own designation in the new classification concept.
Injury, poisoning, and external causes are also within the more detailed ICD-10-CM, including the severity of the injury and how and where it occurred.
History of the ICD 10 CM
The World Health Organization amended ICD 10 to ICD 10 CM (International Classification of Diseases, Tenth Revision, Clinical Modification), which uses a unique set of alphanumeric codes to identify diseases and other health problems.
This special alphanumeric code is known as the CID 10 CM code, a systematic coding system used by physicians and healthcare professionals to facilitate the storage and retrieval of various diagnostic information.
Countries around the world can use the ICD 10 CM diagnostic code to compare and share vital health information in a single or standard language.
This granular or highly specific coding system will better analyze disease patterns and outbreaks.
Prior to the introduction of the ICD 10 CM in the healthcare industry, the ICD 9 CM was used.
Because the ICD 9 CM system lacks specificity and detail, the US health care system has chosen to relocate and use the ICD 10 CM code service.
Codes used to diagnose disturbances in the CID 9 CM were widespread and access was limited, so using this old system for research purposes is unacceptable.
Furthermore, the CID 9 CM uses only 13,000 codes, while the new CID 10 CM has 68,000 codes.
The various health groups such as the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), the Centers for Medicare & Medicaid Services (CMS), the American Medical Association, and the National Center for Health Statistics (NCHS) have approved the use of the ICD 10 CM in several hospitals and health centers.
Does ICD affect Medicaid benefits and reimbursements?
The Centers for Disease Control and Prevention (CDC) advises all institutions subject to the Health Insurance Portability and Accountability Act and the American Medical Association to transition their system to the ICD 10 CM CPT codes by October 1, 2015.
The number of available codes will be much higher, from 13,000 to 68,000 diagnostic codes.
The various services, diagnoses, treatments, and procedure codes fall under the Diagnostic Groups (DRG) software, which is central to the process of ordering and paying for Medicaid services based on the specific DRG.
Reimbursement rates based on the Medicare Wage Percentage will have the least impact, while reimbursement rates based on the per-case negotiated fixed rate linked to DRGs will be the most affected.
ICD 10 for low testosterone levels
A doctor can diagnose low testosterone after a thorough physical exam and a series of blood test results.
Low levels of total testosterone combined with signs and symptoms of hypogonadism are prerequisites for the clinical diagnosis of testosterone deficiency.
The normal range for total testosterone levels is between 300 and 1000 ng/dL (10.5 to 35 nmol/L).
Testosterone hormone blood test results below 300 ng/dL, performed on two separate occasions in the early morning hours (before 10 am), should be the basis for a correct diagnosis of low testosterone hormone.
Patients with unexplained anemia, bone density loss, diabetes, chemotherapy or radiotherapy (eg, for breast cancer), HIV/AIDS, drug use, male infertility, endocrine disorders, pituitary dysfunction, and chronic corticosteroid use also need to be evaluated for testosterone deficiency, even if there are no associated signs and symptoms.
The use of questionnaires is not an effective tool for identifying patients who are potential candidates for testosterone replacement therapy or for monitoring signs and symptoms in patients on testosterone therapy.
Low levels of the hormone testosterone can be caused by many factors such as aging, testicular dysfunction or the inability of the testes to produce testosterone (primary hypogonadism), disorders of the hypothalamus or pituitary gland (secondary hypogonadism), disorders of the endocrine glands and metabolic diseases .
The testicular dysfunction 2022 ICD-10-CM diagnostic code is E29.
This classification is subdivided into four categories: overactive testicular function (E29.0), hypoactive testicular function (E29.1), other types of testicular dysfunction (E29.8) and unspecified testicular dysfunction (E29.9).
The 2022 ICD-10-CM testicular dysfunction diagnostic code is E29.1.
This disorder is a type of primary hypogonadism in which the testicle is unable to produce and maintain adequate levels of the hormone testosterone in the body.
Klinefelter syndrome is one of the most common genetic causes of primary hypogonadism.
A congenital abnormality of the sex chromosome (both X and Y) occurs when there are two or more X chromosomes in addition to the Y chromosome.
This syndrome results in abnormal testicular development and therefore testosterone underproduction.
Testicular hypofunction (ICD-10-CM diagnostic code E29.1) is a billable type of disorder.
In this case, the ICD-10 CM specific diagnosis code E29.1 can only be used by a male patient for reimbursement purposes and does not apply to females.
However, the new coding system for the 2022 edition of ICD-10-CM E29.1 only took effect on October 1, 2021, so the old American version ICD-10-CM of E29.1 may have a different meaning.
Some possible diagnoses may occur under the same diagnostic code ICD-10-CM E29.1 Testicular Hypofunction for documentation, reimbursement or billing purposes.
These additional code diagnoses are male hypogonadism, hypotestosteronism, and testicular failure with hypogonadism.
ICD-10-CM diagnostic code E29.1 for hypoactive testes only applies to the following causes:
- Hodenhypogonadismus nag
- Defective biosynthesis of testicular androgen NOS
- 5-delta reductase deficiency (in male pseudohermaphroditism)
An imbalance in the hypothalamic-pituitary-gonadal axis can cause male hypogonadism.
The imbalance can be seen between primary hypogonadism (originating in the testes) and secondary hypogonadism (originating in the hypothalamus or pituitary).
Testicular hypofunction is a type of primary hypogonadism in which the Leydig cells in the testes fail to produce testosterone adequately. Leydig cells in the testes are the main producers of testosterone.
The disorder in which Leydig cells are damaged is called eunuchoidism.
Eunuchoidism is the eunuch-like condition in which the male individual has a non-functional testicle resulting in decreased spermatogenesis and testosterone production.
If testicular hypofunction occurs in childhood, the development of secondary sexual characteristics may be impaired.
In adult patients, gynecomastia and eunuchoid body proportions may occur (wingspan is 5 cm greater than height and length from pubis to floor is greater than length from head to pubis by more than 5 cm), indicating that the delay may be due to fusion of epiphyses and increased growth of long bones.
Defective testicular androgen biosynthesis NOS
The normal pathway of androgen biosynthesis involves the production of testosterone from dehydroepiandrosterone (DHEA), androstenedione, and androstenediol in the testes.
The normal development of the male external genitalia is highly dependent on dihydrotestosterone (DHT), which is converted from circulating serum testosterone (T).
The production of steroids (sex steroids, glucocorticoids and mineralocorticoids) uses cholesterol as the main component.
Disorders that result in defective testicular androgen biosynthesis can cause 46,XY Disorder of Sexual Development (DSD).
Adrenal insufficiency (IA), disorder of sexual development (DSD), and gonadal insufficiency can result from genetic mutations in the enzymes and proteins that underpin early biosynthetic pathways.
Defects of androgen biosynthesis in adrenal insufficiency are lipoid-CAH insufficiency, CYP11A1 and HSD3B2.
Lack of CYP17A1 can rarely lead to AI; however, low levels of HSD17B3 or SRD5A2 deficiency are the only significant cause of 46,XY-DSD and gonadal failure.
5-delta reductase deficiency (in male pseudohermaphroditism) (ICD-10-CM E29.1)
5α-reductase is responsible for converting testosterone into the more potent dihydrotestosterone. Changes in the SRD5A2 gene cause 5α-reductase deficiency.
This genetic condition mainly affects sexual development before birth and during puberty.
So, male babies born with this defect may have ambiguous external genitalia or genitalia that look like female.
Male babies often have an extraordinarily small penis (micropenis) and a urethra, or hypospadias, which opens under the penis.
Male pseudohermaphroditism affects the 46,XY chromosomes, resulting in differentiated testes with varying degrees of feminization.
The external genitalia of people with this disorder appear to be predominantly female phenotype with an XY karyotype.
However, other patients appear to be normal males with variable spermatogenesis and pubertal virilization.
The 2022 ICD-10-CM diagnostic code for side effects of drugs used to treat testicular hypofunction is T36 to T50 with a fifth or sixth character 5.
The physician must identify the drugs that may cause the side effect and document them using the ICD 10 CM code (T36 to T50 with the fifth or sixth character).
The World Health Organization (WHO) has provided the ICD-10 CM code range for documenting billable treatment effects including adverse reactions, intoxication and underdosage of drugs, drugs and biological substances T36-T50.
Applicable previous references
Some earlier references are available when using the ICD 10 CM code to explore access to endocrine and metabolic disorders.
This includes the following codes for other reproductive, endocrine, nutritional and metabolic disorders:
- Endocrine, nutritional and metabolic diseases (E00 – E29)
- Other disorders of the endocrine glands (E20-E35)
- testicular dysfunction (E29)
Exclusions for CID 10 CM E29.1
There are several disorders and conditions where the CID 10 CM diagnostic code E29 is not applicable for billing or reimbursement purposes. These disorders have their own ICD 10 CM codes that must be followed:
- The 2022 ICD-10-CM diagnostic code for postprocedural hypothyroidism is E89.5.
- The ICD-10-CM 2022 diagnostic code for androgen insensitivity syndrome is E34.5.
- The 2022 ICD-10-CM diagnostic code for azoospermia or oligospermia NOS is N46.0 to N46.1.
- The diagnostic code ICD-10-CM 2022 for isolated gonadotropin deficiency is E23.0.
- The ICD-10-CM 2022 diagnostic code for Klinefelter syndrome is Q98.0, Q98.1 and Q98.4.
The primary purpose of the ICD is to accurately track disease within a population.
However, American Healthcare, including the Centers for Medicare and Medicaid Services (CMS), benefited greatly from the documentation and leveraged it for billing and reimbursement purposes.
The ICD 10 CM code for testicular hypofunction is E29.1 and WHO provides guidelines to follow when using this code for documentation and reimbursement purposes.
While the doctor, when treating hypothyroidism, identifies a drug that causes side effects, he needs good documentation with the CID code 10 CM.
Certain diagnoses such as B. Postprocedural hypothyroidism have their own ICD 10 CM codes, so they are excluded from the specific code for hypothyroidism.
References and Citations
- 5-Alpha Reductase Deficiency - About the Disease. (2022). Retrieved September 14, 2022 from https://rarediseases.info.nih.gov/diseases/5680/5-alpha-redutase-deficiency
- Cartwright, D. (2013, December). Codes ICD-9-CM to ICD-10-CM: What? Why? As? Retrieved September 13, 2022 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865615/
- Du, H. & Taylor, H.S. (2015). development of the genital system. Principles of Developmental Genetics, 487-504. doi:10.1016/b978-0-12-405945-0.00027-2
- Fluck, EC & Pandey, AV (2014). Testicular steroidogenesis - new genes and signaling pathways. Annales D'Endocrinologie, 75(2), 40-47. doi:10.1016/j.ando.2014.03.002
- Hirsch, I. (2022, Aug. 24). Male hypogonadism - urogenital diseases. Retrieved September 14, 2022 from https://www.merckmanuals.com/professional/genitourinary-disorders/male-reproductive-endocrinology-and-related-disorders/male-hypogonadism
- Hirsch, J., Nicola, G., McGinty, G., Liu, R., Barr, R., Chittle, M., & Manchikanti, L. (2016 April 1). ICD-10: History and Context. Retrieved September 13, 2022 from http://www.ajnr.org/content/37/4/596#:~:text=The%20International%20Classification%20of%20Disease%20%28ICD%29
- Holman, T., & DelVecchio, A. (2018, October 29). What is ICD-10-CM (Clinical Modification)? – Definition by whatis.com. Retrieved September 13, 2022 from https://www.techtarget.com/searchhealthit/definition/ICD-10-CM
- Kumar P, Kumar N, Thakur D and Patidar A (2010, July). Male hypogonadism: symptoms and treatment. Retrieved September 13, 2022 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3255409/
- Mulhall J, Trost L and Brannigan R (2018). Assessment and treatment of testosterone deficiency: AUA guideline. Journal of Urology 2018. Retrieved September 13, 2022 from https://www.auanet.org/guidelines-and-quality/guidelines/testosterone-deficiency-guideline
- Selby, J. & Hills, BJ (2020, November 12). Impact of ICD-10 on reimbursement. Retrieved September 15, 2022 from https://www. managedhealthcareexecutive.com/view/icd-10s-impact-reimbursement
- Sizar, O., & Schwartz, J. (2022). National Center for Biotechnology Information. Retrieved September 13, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK532933/
- Tidy, D. (2018, July 1st). Testosterone deficiency: causes, tests and treatment. Retrieved September 13, 2022 from https://patient.info/mens-health/erectile-dysfunction-impotence/testosterone-deficiency
- What is the ICD (International Classification of Diseases)? (n.d.). Retrieved September 13, 2022 from https://icd.codes/articles/what-is-icd#:~:text=ICD%20codes%20are%20used
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