ICD-10-CM Code for Buffalo Hump
The ICD-10-CM code for buffalo hump (dorsal fat pad) is E24.9 (Cushing's syndrome, unspecified) when it presents as a manifestation of hypercortisolism, or E88.89 (Other specified metabolic disorders) when it occurs as an isolated finding or due to other causes such as medication-induced lipodystrophy.
Clinical Context and Coding Approach
Buffalo hump refers to the abnormal accumulation of fat in the dorsocervical and supraclavicular regions. The appropriate ICD-10-CM code depends on the underlying etiology:
When Associated with Cushing's Syndrome
If the buffalo hump is part of Cushing's syndrome presentation, use E24.9 (Cushing's syndrome, unspecified) or a more specific E24.x code if the etiology is known. 1 The clinical presentation typically includes:
- Central obesity with "moon" face and dorsal/supraclavicular fat pads 1
- Wide (≥1 cm) violaceous striae 1
- Proximal muscle weakness 1
- Hypertension and hyperglycemia 1
- Rapid weight gain with central distribution 1
The presence of buffalo hump alongside these features warrants screening with overnight 1-mg dexamethasone suppression test or 24-hour urinary free cortisol excretion. 1
When Steroid-Induced
For iatrogenic buffalo hump from chronic glucocorticoid therapy, code as E24.2 (Drug-induced Cushing's syndrome). 1 This is particularly relevant in patients receiving:
- Daily prednisone doses ≥15 mg with cumulative exposure >1 gram 1
- Long-term steroid therapy for conditions like autoimmune hepatitis 1
Buffalo hump was reported in up to 50% of patients on steroid-only regimens in classic immunosuppression trials. 1
When Due to Other Causes
For buffalo hump not related to hypercortisolism (such as lipodystrophy from antiretroviral therapy or benign symmetric lipomatosis), use E88.89 (Other specified metabolic disorders). 1
Documentation Requirements
Accurate ICD-10-CM coding requires comprehensive documentation specifying: 2, 3
- The presence and location of the dorsocervical/supraclavicular fat accumulation
- Associated clinical features (moon facies, striae, hypertension, etc.) 1
- Results of biochemical testing if Cushing's syndrome is suspected 1
- Medication history, particularly glucocorticoid use 1
- Whether the finding is isolated or part of a syndrome
Common Coding Pitfalls
Avoid coding buffalo hump as simple obesity (E66.x) when it represents a specific fat distribution pattern associated with endocrine or metabolic disease. The dorsocervical and supraclavicular fat pad distribution is pathognomonic for hypercortisolism or specific lipodystrophy syndromes, not generalized obesity. 1
Do not use unspecified codes when the underlying cause is documented. If Cushing's syndrome is confirmed, specify the etiology (pituitary E24.0, adrenal E24.3, ectopic E24.1, drug-induced E24.2) rather than defaulting to E24.9. 1