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ICD-10 Guide
ICD-10 CodesD35.2

D35.2

Billable

Benign neoplasm of pituitary gland

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

Code Description

ICD-10 D35.2 is a billable code used to indicate a diagnosis of benign neoplasm of pituitary gland.

Key Diagnostic Point:

Benign neoplasms of the pituitary gland, such as adenomas, are non-cancerous tumors that arise from the pituitary tissue. These tumors can lead to various hormonal imbalances depending on the type of hormone they produce, such as prolactin, growth hormone, or adrenocorticotropic hormone (ACTH). Clinically, patients may present with symptoms related to hormonal excess, such as galactorrhea, acromegaly, or Cushing's disease, or they may experience symptoms due to mass effect, including headaches and visual disturbances. Diagnosis typically involves imaging studies like MRI to visualize the tumor and assess its size and effect on surrounding structures. Treatment options may include observation, medication to control hormone levels, or surgical intervention if the tumor is causing significant symptoms or complications. Regular follow-up is essential to monitor for changes in tumor size or hormone levels.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of symptoms based on hormone production
  • Need for imaging studies for accurate diagnosis
  • Potential for co-existing conditions affecting treatment
  • Variability in treatment approaches based on tumor characteristics

Audit Risk Factors

  • Inadequate documentation of hormonal assays
  • Failure to document imaging studies
  • Misclassification of tumor type
  • Lack of follow-up documentation

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Thorough documentation of hormonal levels, symptoms, and treatment plans.

Common Clinical Scenarios

Patients presenting with symptoms of hormonal excess or deficiency.

Billing Considerations

Ensure accurate coding of hormone levels and related conditions.

Neurosurgery

Documentation Requirements

Detailed operative reports and post-operative follow-up notes.

Common Clinical Scenarios

Surgical intervention for large pituitary adenomas causing neurological symptoms.

Billing Considerations

Document the extent of resection and any complications.

Coding Guidelines

Inclusion Criteria

Use D35.2 When
  • Follow ICD
  • CM guidelines for coding neoplasms, ensuring to document the benign nature of the tumor and any associated symptoms
  • Include relevant imaging and lab results to support the diagnosis

Exclusion Criteria

Do NOT use D35.2 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

60270CPT Code

Transsphenoidal resection of pituitary tumor

Clinical Scenario

Used for surgical treatment of pituitary adenomas.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Neurosurgeons must document the extent of tumor resection.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of benign neoplasms, improving the accuracy of diagnosis and treatment tracking for conditions like D35.2.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of benign neoplasms, improving the accuracy of diagnosis and treatment tracking for conditions like D35.2.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of benign neoplasms, improving the accuracy of diagnosis and treatment tracking for conditions like D35.2.

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 a pituitary adenoma?

Common symptoms include headaches, visual disturbances, hormonal imbalances leading to conditions like acromegaly or Cushing's disease, and galactorrhea in prolactinomas.