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What Is The ICD 10 Code For Metabolic Syndrome?

ICD is the shorthand for International Classification of Diseases, Tenth Revision. ICD is a system of codes developed by World Health Organization (WHO) used by physicians and other health care professionals in the classification of diseases, specification of diagnosis, symptoms and treatment procedures that can be recorded under the care of a hospital. The medical and health information of a patient can be condensed and recorded as a code form, so that patients can claim medical benefits provided in medical schemes under these codes. These codes also help in the classification and compilation of morbidity and mortality of the patients. It is specifically helpful in the storage and retrieval of diagnostic information in relation to each disease in the vast array of diseases.1

ICD-10 codes are frequently revised since its adoption and even before its adoption in the US healthcare system. 2019 ICD-10 codes have been revised, which were effective from 1st October, 2018 and will be applicable until 30th September 2019. The updated 2019 ICD-10 guidelines contain 279 new codes, 143 revised codes and 51 removed codes with an altogether of 71,932 codes all in all.2

What Is The ICD 10 Code For Metabolic Syndrome?

As per 2019 ICD-10 diagnostic code, metabolic syndrome is classified under E88.81 code, which is a billable code (can be used for reimbursement purposes) is a highly specific to metabolic syndrome. This is the ICD-10 diagnostic code for US and the ICD-10 codes for different countries can vary accordingly.3

Metabolic syndrome can be synonymous to drug resistance to insulin, metabolic syndrome x, dysmetabolic syndrome x and insulin resistance. It is considered an assemblage of various metabolic risk factors for type 2 diabetes mellitus and cardiovascular diseases. The various risk factors include abdominal fat circumference of 35” for women and 40” for men, elevated lipid profile, elevated blood pressure, and elevated blood glucose levels along with insulin resistance, which gives rise to a pro-inflammatory state in the body. The culprit for metabolic syndrome is overweight/obesity, sedentary lifestyle/lack of physical activity and to some extent genetic factors. It is a compilation of medical conditions that increases the risk of diabetes mellitus, heart attack and stroke.

It is associated with high levels of triglycerides along with low density lipoproteins (bad cholesterol) and cholesterol with low levels of high-density lipoproteins (good cholesterol) and high levels of fasting blood glucose.4

Obesity is known to play a pivotal role in metabolic syndrome as it is linked to all the other risk factors. In women, waist circumference of 80 cm or more and in men 90-94 cm or more is considered a factor for increased likelihood of metabolic syndrome.5

The optimal blood pressure for individuals is 120/80 mmHg; however, blood pressure greater than 130/85 mmHg is a risk factor for metabolic syndrome. People with already established history of hypertension on medication are automatically at a higher risk for metabolic disease. High blood pressure is associated with other diseases including cardiovascular diseases, kidney diseases and stroke.

Triglyceride levels of 150 mg/dl or more and low density lipoprotein level of 130 mg/dl or more along with high density lipoprotein level of 40 mg/dl or less puts an individual in the scale for metabolic syndrome. Increase in LDL and triglycerides leads to build up of fatty layer in the tissues or even in the arteries, whereas, HDL is responsible for the prevention of this fatty layer build up.

Fasting blood glucose levels should be around 60-99 mg/dl. Fasting glucose levels of 100 or greater falls under impaired fasting blood glucose levels and in the level of 114-126 mg/dl is pre-diabetic range, over 126 mg/dl is diabetic range. Obesity can lead to insulin desensitization of the tissues against insulin, thus, elevating the blood glucose levels.

All the above risk factors can be prevented by regular monitoring of the above symptoms along with lifestyle changes with diet and exercise, keeping obesity at bay and leading a healthy lifestyle.


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Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:February 3, 2022

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