Cushing's syndrome is a hormonal disorder that occurs due to long-term exposure to cortisol (a hormone that your adrenal gland makes). Learn more about the diagnosis, treatment modalities, and documentation guidelines for this hormonal condition.

1. DOCUMENTING
CUSHING’S SYNDROME
with ICD-10 Codes
Learn more about the diagnosis,
treatment modalities, and
documentation guidelines for
Cushing's syndrome.
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2. Cushing’s syndrome is a hormonal disorder caused by prolonged exposure of
the body’s tissues to abnormally high levels of the hormone cortisol. Also
called hypercortisolism, this condition may be caused by the overuse of oral
corticosteroid medications. It can also occur when the body produces too
much cortisol on its own. The condition is relatively rare and mostly affects
people (females) in the age group of 20-50 years, who have been regularly
consuming steroid medications for a long time. On the other hand, people
who are obese and suffer from Type 2 diabetes (along with poorly controlled
blood sugar and high blood pressure) can have an increased risk of
developing the disorder. The treatment for this hormonal disorder mainly
depends on the potential causes of the condition. The treatment focuses on
reducing the level of cortisol in the patient’s body thereby effectively
controlling the symptoms. For accurate clinical documentation of this
disorder, physicians can opt for medical billing outsourcing services.
Before going on to the medical codes for Cushing’s syndrome, let us look at
the symptoms of this condition and how it is diagnosed.
Signs and Symptoms
The signs and symptoms of Cushing’s syndrome may vary depending on the
levels of excess cortisol. Common symptoms include –
❖ Weight gain and fatty tissue deposits (particularly around the
midsection and upper back, in the face and between the shoulders)
❖ Thinning, fragile skin that bruises easily
❖ Slow healing of cuts, insect bites and infections
❖ Severe fatigue and muscle weakness
❖ Pink or purple stretch marks (on the skin of the abdomen, thighs,
breasts and arms)
❖ New or worsened high blood pressure
❖ Loss of emotional control
❖ Headache
❖ Cognitive difficulties
❖ Acne
Women with this hormonal condition may experience thicker/visible body
and facial hair and irregular or absent menstrual periods. On the other hand,
men suffering from this condition may experience reduced fertility, erectile
dysfunction and decreased libido.

3. How is Hypercortisolism Diagnosed and Documented?
Diagnosing Cushing’s syndrome, (also called hypercortisolism) is very
difficult as this condition has many different causes, and certain signs and
symptoms are similar to other conditions. The diagnosis is made based on
abnormal cortisol levels in the body. As part of the initial diagnosis, the
physician will perform a detailed physical examination and review your
previous medical history. In addition they may look for symptoms such as -
rounding of the face (moon face), fatty tissues between the shoulders and
neck (buffalo hump), and thin skin with bruises and stretch marks. Several
laboratory tests such as – blood tests, urinary free cortisol test, petrosal
sinus sampling test and dexamethasone suppression test will be conducted.
Imaging tests such as CT scans or MRI scans will also be performed to
produce images of pituitary and adrenal glands to detect abnormalities, such
as tumors.
Treatments for this condition may include medications (to reduce cortisol
production in the adrenal glands or reduce ACTH production in the pituitary
gland) and radiation therapy (if malignant or cancerous tumors are present)
and surgery.
Endocrinologists are reimbursed for the treatments provided to their
patients. The diagnosis and other tests offered must be reported on the
medical claims using the correct medical codes. Medical billing and coding
services provided by reputable companies can help physicians use the
correct codes for medical billing. The following ICD-10 codes are to be used
for Cushing’s syndrome –
E24 - Cushing's syndrome
➢ E24.0 - Pituitary-dependent Cushing's disease
➢ E24.1 - Nelson's syndrome
➢ E24.2 - Drug-induced Cushing's syndrome
➢ E24.3 - Ectopic ACTH syndrome
➢ E24.4 - Alcohol-induced pseudo-Cushing's syndrome
➢ E24.8 - Other Cushing's syndrome
➢ E24.9 - Cushing's syndrome, unspecified

4. E 24 should not be used for reimbursement purposes, but the multiple codes
below it that are more specific are billable and should be reported on the
medical claim to indicate a diagnosis for reimbursement.
The sooner the treatment begins the better will be the expected outcomes.
The length of recovery from this condition will mainly depend on the severity
of symptoms and specific causes.