ICD-10 Code for PCP Referral to Endocrinology for Parathyroid Adenoma History
The appropriate ICD-10 code for a PCP referral to endocrinology due to a history of parathyroid adenoma is D35.1 (Benign neoplasm of parathyroid gland).
Coding Rationale and Clinical Context
- Parathyroid adenomas are the most common cause of primary hyperparathyroidism (PHPT), accounting for 80-85% of PHPT cases 1, 2
- When coding for a referral to endocrinology for a patient with history of parathyroid adenoma, the underlying condition (the adenoma itself) should be coded, not just the referral reason 1
Clinical Significance of Parathyroid Adenomas
- Parathyroid adenomas cause autonomous overproduction of parathyroid hormone (PTH), typically resulting in hypercalcemia 1
- PHPT is more common in women, with an incidence of 66 per 100,000 person-years versus 25 per 100,000 person-years in men 1
- Most cases are sporadic, although hereditary causes exist, including multiple endocrine neoplasia (MEN) types 1 and 2A, as well as familial hyperparathyroidism 1
Indications for Specialist Referral
Referral to endocrinology is particularly important in patients with:
- Parathyroid adenoma diagnosed at age <30 1
- Parathyroid adenoma with multiple glands involved 1
- Parathyroid adenoma and thymic or bronchial carcinoid, pancreatic neuroendocrine tumor, pituitary tumor, or adrenal tumor in the same person 1
- Parathyroid adenoma and a family history of hyperparathyroidism, pituitary adenoma, pancreatic islet cell tumor, or foregut carcinoid tumor 1
Genetic Considerations
- Patients with parathyroid adenomas meeting certain criteria should be considered for genetic counseling for potential MEN1 (OMIM 131100) or MEN2 (OMIM 171400,155240,162300) syndromes 1
- Genetic testing is particularly important when parathyroid adenomas occur at a young age or in the context of other endocrine tumors 1
Clinical Course and Management
- Treatment of PHPT is typically surgical excision of the abnormally functioning parathyroid tissue 1
- Surgery is indicated even when asymptomatic, given potential negative effects of long-term hypercalcemia 1
- Two accepted curative operative strategies exist: bilateral neck exploration (BNE) and minimally invasive parathyroidectomy (MIP) 1
- Persistent or recurrent PHPT may occur, requiring additional imaging and potential reoperation 1
Coding Pitfalls to Avoid
- Do not use symptom codes (such as hypercalcemia) when the underlying condition (parathyroid adenoma) is known 1
- Avoid using general endocrine disorder codes when a specific code for the parathyroid neoplasm exists 1
- If the patient has a genetic syndrome associated with parathyroid adenoma (such as MEN1 or MEN2), consider additional coding to reflect this underlying condition 1