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ICD-10 Guide
ICD-10 CodesE27.4

E27.4

Billable

Other and unspecified adrenocortical insufficiency

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 E27.4 is a billable code used to indicate a diagnosis of other and unspecified adrenocortical insufficiency.

Key Diagnostic Point:

Adrenocortical insufficiency refers to a condition where the adrenal glands do not produce adequate amounts of steroid hormones, particularly cortisol. This insufficiency can be primary, secondary, or tertiary, depending on the underlying cause. Primary adrenal insufficiency, also known as Addison's disease, occurs when the adrenal glands are damaged, often due to autoimmune processes, infections, or tumors. Secondary adrenal insufficiency arises from inadequate stimulation of the adrenal glands by adrenocorticotropic hormone (ACTH) from the pituitary gland, which can occur due to pituitary disorders or prolonged use of corticosteroids. Tertiary adrenal insufficiency is related to hypothalamic dysfunction. Symptoms of adrenocortical insufficiency may include fatigue, weight loss, low blood pressure, hyperpigmentation of the skin, and electrolyte imbalances. Diagnosis typically involves hormonal assays, imaging studies, and stimulation tests to evaluate adrenal function. Treatment focuses on hormone replacement therapy and addressing the underlying cause of the insufficiency.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes (primary, secondary, tertiary)
  • Need for comprehensive hormonal evaluation
  • Potential overlap with other endocrine disorders
  • Variability in clinical presentation

Audit Risk Factors

  • Inadequate documentation of symptoms
  • Lack of clear diagnosis from the provider
  • Failure to document hormone levels and tests performed
  • Misclassification of primary vs. secondary causes

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Detailed hormonal assay results, imaging studies, and clinical symptoms must be documented.

Common Clinical Scenarios

Patients presenting with fatigue, weight loss, and hypotension; patients with known autoimmune disorders.

Billing Considerations

Endocrinologists must ensure that all relevant lab results are included in the documentation to support the diagnosis.

Internal Medicine

Documentation Requirements

Comprehensive patient history and physical examination findings, including vital signs and symptomatology.

Common Clinical Scenarios

Patients with unexplained fatigue, electrolyte imbalances, or acute adrenal crisis.

Billing Considerations

Internal medicine physicians should document any differential diagnoses considered and the rationale for the final diagnosis.

Coding Guidelines

Inclusion Criteria

Use E27.4 When
  • According to ICD
  • 10 coding guidelines, E27
  • 4 should be used when the specific type of adrenocortical insufficiency is not documented
  • Coders should ensure that the documentation supports the diagnosis and that any relevant tests are noted

Exclusion Criteria

Do NOT use E27.4 When
  • Exclusion criteria include conditions that are clearly defined under other specific codes

Related ICD-10 Codes

Related CPT Codes

84520CPT Code

Cortisol level test

Clinical Scenario

Used to evaluate adrenal function in patients suspected of adrenal insufficiency.

Documentation Requirements

Document the reason for the test and any relevant clinical findings.

Specialty Considerations

Endocrinologists should ensure that the test results are interpreted in the context of the patient's overall clinical picture.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of adrenal insufficiency, improving the accuracy of diagnoses and treatment plans. E27.4 provides a necessary option for cases where the specific type of insufficiency is not clearly defined, allowing for better tracking of patient outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of adrenal insufficiency, improving the accuracy of diagnoses and treatment plans. E27.4 provides a necessary option for cases where the specific type of insufficiency is not clearly defined, allowing for better tracking of patient outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of adrenal insufficiency, improving the accuracy of diagnoses and treatment plans. E27.4 provides a necessary option for cases where the specific type of insufficiency is not clearly defined, allowing for better tracking of patient outcomes and resource allocation.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the common symptoms of adrenocortical insufficiency?

Common symptoms include fatigue, weight loss, low blood pressure, hyperpigmentation, and electrolyte imbalances. Patients may also experience gastrointestinal symptoms such as nausea and vomiting.

How is adrenocortical insufficiency diagnosed?

Diagnosis typically involves measuring serum cortisol levels, conducting an ACTH stimulation test, and possibly imaging studies to assess adrenal gland structure.

What is the treatment for adrenocortical insufficiency?

Treatment usually involves hormone replacement therapy with glucocorticoids and, in some cases, mineralocorticoids, depending on the specific type of insufficiency.