What is the ICD‑10 (International Classification of Diseases, 10th Revision) code for vitamin D deficiency?

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ICD-10 Code for Vitamin D Deficiency

The ICD-10 code for vitamin D deficiency is E55.9 (Vitamin D deficiency, unspecified), which is the most commonly used code when no specific manifestation such as rickets or osteomalacia is documented. 1

Primary Coding Options

  • E55.9 is the standard code for vitamin D deficiency without documented skeletal manifestations and should be used for most cases of nutritional vitamin D deficiency 1
  • E55.0 should be used specifically when active rickets is present in children with severe vitamin D deficiency 1
  • M83.9 is appropriate when adult osteomalacia has developed as a consequence of severe deficiency 1

Clinical Thresholds for Coding

  • Vitamin D deficiency is clinically defined as serum 25-hydroxyvitamin D [25(OH)D] levels below 20 ng/mL (50 nmol/L) 2, 3
  • Severe vitamin D deficiency is defined as levels below 10-12 ng/mL, which dramatically increases the risk for osteomalacia and nutritional rickets 2, 1
  • Vitamin D insufficiency (levels 20-30 ng/mL) is a distinct entity from deficiency and may warrant different coding considerations 3

Documentation Requirements

  • Document the actual 25(OH)D level in ng/mL or nmol/L to justify the diagnosis and severity designation 1
  • Record any secondary hyperparathyroidism, which develops progressively as levels fall below 20 ng/mL and worsens with severe deficiency 1
  • Note specific manifestations such as bone pain, muscle weakness, or radiographic evidence of rickets/osteomalacia to support more specific coding 3

Risk Factors to Document

  • Malabsorption syndromes (post-bariatric surgery, inflammatory bowel disease, celiac disease) 1
  • Severe kidney or liver dysfunction 1
  • Dark skin pigmentation (associated with 2-9 times higher prevalence of low vitamin D levels) 1
  • Obesity (causes vitamin D sequestration in adipose tissue) 1
  • Limited sun exposure, extensive clothing coverage, or institutionalization 2

Common Coding Pitfalls

  • Avoid coding as E55.9 (unspecified) when specific manifestations like rickets or osteomalacia are present—use the more specific codes E55.0 or M83.9 instead 1
  • Do not confuse vitamin D insufficiency (20-30 ng/mL) with deficiency (<20 ng/mL), as these may have different clinical implications 3
  • Remember that inflammation (CRP >40 mg/L) significantly reduces plasma vitamin D levels, which may complicate interpretation and coding 2, 1

Treatment Documentation for Coding

  • Severe deficiency typically requires loading doses of 50,000 IU weekly for 8-12 weeks, which should be documented in the treatment plan 1, 3
  • Follow-up 25(OH)D levels after 3-6 months to confirm adequate response may affect ongoing coding 1
  • The target level of at least 30 ng/mL for anti-fracture efficacy should be documented as the treatment goal 1

References

1
Guideline

Severe Vitamin D Deficiency Diagnosis and Coding

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

2
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Research

Recognition and management of vitamin D deficiency.

American family physician, 2009

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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