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ICD-10 Guide
ICD-10 CodesR85.1

R85.1

Abnormal level of hormones in specimens from digestive organs and abdominal cavity

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 R85.1 is a billable code used to indicate a diagnosis of abnormal level of hormones in specimens from digestive organs and abdominal cavity.

Key Diagnostic Point:

R85.1 refers to abnormal hormone levels detected in specimens obtained from the digestive organs and abdominal cavity. Hormones such as gastrin, insulin, glucagon, and others play critical roles in digestion and metabolism. Abnormal levels may indicate various underlying conditions, including endocrine disorders, tumors, or metabolic syndromes. Symptoms may vary widely, including gastrointestinal disturbances, unexplained weight changes, or metabolic imbalances. Laboratory findings may reveal elevated or decreased hormone levels, prompting further investigation into potential causes. Accurate diagnosis often requires correlating laboratory results with clinical symptoms and imaging studies to identify the underlying pathology. This code is essential for capturing the complexity of hormonal imbalances that do not fit neatly into other classifications, ensuring appropriate treatment and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of hormones involved and their complex interactions
  • Need for comprehensive laboratory testing and interpretation
  • Potential overlap with other endocrine disorders
  • Variability in clinical presentation among patients

Audit Risk Factors

  • Inadequate documentation of laboratory results
  • Failure to correlate symptoms with abnormal findings
  • Misclassification of hormone levels as normal
  • Lack of specificity in the diagnosis

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed lab results, clinical correlation, and patient history.

Common Clinical Scenarios

Patients presenting with unexplained weight loss, metabolic syndrome, or gastrointestinal symptoms.

Billing Considerations

Ensure comprehensive documentation of all relevant hormone levels and associated symptoms.

Emergency Medicine

Documentation Requirements

Acute care notes, lab results, and immediate clinical findings.

Common Clinical Scenarios

Acute presentations of adrenal crisis or severe metabolic disturbances.

Billing Considerations

Rapid assessment and documentation of hormone levels are crucial for timely intervention.

Coding Guidelines

Inclusion Criteria

Use R85.1 When
  • Follow official ICD
  • CM coding guidelines, ensuring that the code is used only when there is clear documentation of abnormal hormone levels from digestive organs or the abdominal cavity
  • Ensure that the clinical context supports the use of this code

Exclusion Criteria

Do NOT use R85.1 When
No specific exclusions found.

Related CPT Codes

84144CPT Code

Insulin, serum

Clinical Scenario

Used when testing for insulin levels in patients suspected of having metabolic disorders.

Documentation Requirements

Document the reason for testing and correlate with clinical findings.

Specialty Considerations

Endocrinologists may frequently order this test in conjunction with R85.1.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of hormonal abnormalities, improving the accuracy of diagnoses and treatment plans. R85.1 provides a distinct classification for abnormal hormone levels, enhancing data collection and analysis.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of hormonal abnormalities, improving the accuracy of diagnoses and treatment plans. R85.1 provides a distinct classification for abnormal hormone levels, enhancing data collection and analysis.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of hormonal abnormalities, improving the accuracy of diagnoses and treatment plans. R85.1 provides a distinct classification for abnormal hormone levels, enhancing data collection and analysis.

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 types of hormone abnormalities does R85.1 cover?

R85.1 covers a range of hormone abnormalities from digestive organs, including but not limited to insulin, glucagon, gastrin, and others that may affect metabolism and digestion.