Are You at Risk for a Women’s Health Issue?

ICD-10 codes for the top five women’s health issues are provided in this report.

Heart disease, breast cancer, osteoporosis, depression, and autoimmune diseases are the top five women’s health issues, according WebMD. This article will provide information such as risk factors, treatment, and the ICD-10-CM associated codes (of course!).

Heart disease is the leading cause of death for women and men, but women are experiencing premature (in their 60s) death. The risk factors of heart disease are smoking, high blood pressure, high cholesterol, physical inactivity, obesity/overweight, and diabetes. The preventative treatment for this disease is healthy eating and exercise.  

Heart disease is coded I51.9 but as clinical documentation integrity specialists interact with the physicians, this diagnosis can be further specified as arteriosclerotic heart disease (I25.10), ischemic (I25.9), valvular (38), hypertensive (I11.9). More specificity would be needed to incorporate associated signs and symptoms such as angina (I20 or combination code I25.110); congestive heart failure (I50.9); location (mitral, aortic, pulmonary, or multiple); and type of tissue (native or bypassed arteries).

Breast cancer is the most common health issue for women, but lung cancer is the leading cause of death among women. Breast cancer is very treatable with today’s medicine and it is important to understand patients’ options for treatment if they are diagnosed. Risk factors include increasing age, genes (i.e. BRCA1 and BRCA2), family history, personal history, race (more Caucasian women are treated, but more African-American women die from the disease), earlier abnormal breast biopsy, earlier chest radiation, early onset (before age 12) of menstruation or menopause after age 55, not having children, medication use (such as DES), high alcohol consumption, and obesity. According to the Center of Disease Control (CDC), regular mammograms are the best preventative approach.

Category C50 contains all of the breast cancer codes including location, laterality, and gender, as men may also be diagnosed with breast cancer. If the patient is presenting after treatment is completed for follow-up examination, the ICD-10-CM code would be Z08. If the patient presents for screening mammogram, the code would be Z12.31. The inconclusive mammogram is coded as R92.2. This diagnosis is important as it includes the term “dense breasts,” which meets medical necessity in some circumstances. Genetic susceptibility to breast cancer is found under Z15.01. The estrogen receptor status is coded from a code in category Z17. This category identifies the receptor status as positive or negative. If the patient presents for reconstructive surgery after a previous mastectomy, the ICD-10-CM code is Z42.1. The encounter for adjustment or fitting of external breast prosthesis is coded from subcategory of Z44.3 which includes laterality. Sub-sub-category Z45.81- provides the code for adjustment or removal of breast implant and also includes laterality. The Official Guidelines for Coding and Reporting state that when a patient is admitted for the sole purpose of radiotherapy (Z51.0), chemotherapy (Z51.11), or immunotherapy (Z51.12), the Z51.- code must be reported as the principal diagnosis. Family history of breast cancer can be captured with Z80.3 and personal history of breast cancer can be reported with Z85.3. There are many more diagnosis codes, depending on situations, but these previously mentioned codes are the most prevalent.

Osteoporosis is a concern of 44 million Americans, and 68 percent are women. This condition is preventable with calcium consumption and weight-bearing physical activity. The risk factors for this condition are gender (female), increasing age, small or thin-boned frame, ethnicity (Caucasian and Asian have increased risk), family history, estrogen loss, anorexia, diet low in calcium and vitamin D, medication use, sedentary life style, smoking, and excessive alcohol.  

The ICD-10-CM codes for osteoporosis are found under categories M80 (with a current pathologic fracture) and M81 (without current pathologic fracture). The M80 category includes the location of the fracture including laterality to be a more specific diagnosis code. The seventh character for M80 category identifies if the fracture is under current treatment, the fracture has healed and is past active treatment, or if a residual condition exists due to osteoporosis with fracture. Sub-category M81.0 is age-related osteoporosis without current fracture, M81.6 is local osteoporosis, and M81.8 is other osteoporosis which includes drug-induced, post-surgical, post-traumatic, and idiopathic without fracture. Screening for osteoporosis can be coded as Z13.820. Family history is identified with code Z82.62.  

Depression impacts women far more frequently than men (12 million vs. 6 million Americans). The risk factors for depression include hormonal changes, previous depressive episode, history of heart problems, serious chronic illness, marital problems, substance abuse, medication (e.g. antihypertensives or anti-seizure), stressful life event, recent serious illness/injury, disease that triggers depression (e.g., vitamin deficiency, thyroid disease), childhood history of physical/sexual abuse, and being a worrier, overly anxious, or having an eating disorder. The best preventive treatment is to find a reason to get up in the morning and maintain caring relationships.   

Diagnosis code F32.9 is the default for depression. Using clinical documentation integrity skills can further specify this code with single or recurrent episode information and the severity (mild, moderate, severe, or severe with psychotic features). Screening for depression is coded as Z13.89 and family history is coded as of mental disease is Z81.8. Please note that this family history code is not very specific as it includes the entire Mental and Behavioral Disorders chapter.

Autoimmune diseases include more than 80 serious chronic illnesses such as lupus, multiple sclerosis, and type 1 diabetes. The autoimmune diseases are the fourth leading reason for disability among American women. The autoimmune disease causes the body to turn on itself. It is not known why the body’s cells begin to attack.

Autoimmune disease is coded as M35.9 without any specification. Clinical documentation integrity skills would query to get the specific disease. Lupus erythematosus is coded as L93.0 and systemic is coded as M32.9 and requires further specificity to indicate organ involvement. If the lupus is not systemic then the specific involved location should be specified for the most accurate code. Multiple sclerosis is coded as G35. This code has no further specification. Diabetes type 1, also known as juvenile onset diabetes, is coded as E10.9, which should be further specified with any known complications of the disease. Family history of diabetes is coded as Z83.3. The code (Z79.4) for insulin usage is not coded with type 1 diabetes.

In conclusion, there is some commonality among the risk factors for these diseases—family history, obesity/overweight, smoking, increasing age, and high alcohol/substance use. From a mental health perspective, people need to keep active and connected to others. Although we are talking about women’s health issues, it seems to be good advice for all people.

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