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ICD-10 Guide
ICD-10 CodesE72.20

E72.20

Billable

Disorder of urea cycle metabolism, unspecified

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

Code Description

ICD-10 E72.20 is a billable code used to indicate a diagnosis of disorder of urea cycle metabolism, unspecified.

Key Diagnostic Point:

Disorders of urea cycle metabolism encompass a group of inherited metabolic conditions that result from deficiencies in one of the enzymes responsible for the urea cycle, a critical pathway for the detoxification of ammonia in the body. These disorders can lead to the accumulation of ammonia in the bloodstream, which can be toxic and result in severe neurological damage if not promptly treated. The urea cycle involves several key enzymes, including carbamoyl phosphate synthetase I, ornithine transcarbamylase, argininosuccinate synthetase, and argininosuccinate lyase. Symptoms of urea cycle disorders can vary widely, ranging from mild to severe, and may include lethargy, vomiting, seizures, and in severe cases, coma. Diagnosis typically involves biochemical testing to measure enzyme activity and genetic testing to identify specific mutations. Management often includes dietary modifications, ammonia scavenger medications, and in some cases, liver transplantation. The unspecified designation indicates that the specific enzyme deficiency has not been determined, which can complicate treatment and management strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of symptoms
  • Need for biochemical and genetic testing for accurate diagnosis
  • Potential for multiple enzyme deficiencies complicating the condition
  • Differentiation from other metabolic disorders

Audit Risk Factors

  • Inadequate documentation of clinical symptoms
  • Failure to document biochemical testing results
  • Lack of clarity on dietary management strategies
  • Misidentification of the disorder leading to incorrect coding

Specialty Focus

Medical Specialties

Genetics

Documentation Requirements

Detailed family history and genetic testing results must be documented.

Common Clinical Scenarios

Patients presenting with unexplained neurological symptoms or metabolic crises.

Billing Considerations

Genetic counseling may be necessary for family planning and understanding inheritance patterns.

Pediatrics

Documentation Requirements

Growth and developmental assessments, along with dietary intake records.

Common Clinical Scenarios

Infants or children with failure to thrive or recurrent vomiting.

Billing Considerations

Monitoring for developmental delays and nutritional status is crucial.

Coding Guidelines

Inclusion Criteria

Use E72.20 When
  • According to ICD
  • 10 coding guidelines, E72
  • 20 should be used when the specific enzyme deficiency is not documented
  • Coders should ensure that the clinical documentation supports the diagnosis and that any related conditions are also coded appropriately

Exclusion Criteria

Do NOT use E72.20 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

81200CPT Code

Genetic testing for urea cycle disorders

Clinical Scenario

Used when genetic testing is performed to confirm a suspected urea cycle disorder.

Documentation Requirements

Documentation of clinical indications for testing and results.

Specialty Considerations

Genetic counseling may be required for interpretation of results.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of metabolic disorders, including urea cycle disorders. This has improved the ability to track and manage these conditions but has also introduced complexity in coding due to the need for precise documentation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of metabolic disorders, including urea cycle disorders. This has improved the ability to track and manage these conditions but has also introduced complexity in coding due to the need for precise documentation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of metabolic disorders, including urea cycle disorders. This has improved the ability to track and manage these conditions but has also introduced complexity in coding due to the need for precise documentation.

Resources

Clinical References

  • •
    Urea Cycle Disorders Association

Coding & Billing References

  • •
    Urea Cycle Disorders Association

Frequently Asked Questions

What should I document to support the use of E72.20?

Document the patient's clinical symptoms, any biochemical testing results, and the rationale for using the unspecified code, including the absence of specific enzyme identification.