Prolactinoma, a common type of pituitary tumor, necessitates precise diagnostic coding for medical billing, record-keeping, and epidemiological tracking. In the United States, the ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) system is used, and the specific diagnosis code for benign neoplasm of the pituitary gland, which includes prolactinoma, is D35.2. This article aims to provide a comprehensive understanding of the Diagnosis Code For Prolactinoma, focusing on ICD-10-CM code D35.2.
What is ICD-10-CM Code D35.2?
ICD-10-CM code D35.2 is designated for “Benign neoplasm of pituitary gland.” This is a billable and specific code, meaning it can be used directly on medical claims for reimbursement. The code officially came into effect in October 2015 and has been consistently updated annually, with the current 2025 edition effective from October 1, 2024. It’s crucial to use ICD-10-CM codes for diagnoses made on or after October 1, 2015, for accurate medical coding and billing in the US healthcare system.
This code encompasses various benign neoplasms of the pituitary gland, including different types of adenomas and specifically, prolactinomas. It is important to note that D35.2 refers to benign conditions, meaning non-cancerous tumors that do not spread to other parts of the body.
Synonyms and Clinical Terms Associated with D35.2
To fully grasp the scope of D35.2, it’s helpful to understand the range of terms that are considered clinically synonymous and fall under this diagnosis code. These include:
- Adenoma of pituitary
- Adenoma pituitary, functionless
- Benign neoplasm of pituitary
- Benign neoplasm pituitary, macroadenoma
- Benign neoplasm pituitary, microadenoma
- Benign neoplasm, macroprolactinoma
- Benign neoplasm, microprolactinoma
- Functionless pituitary adenoma
- Macroprolactinoma
- Microprolactinoma
- Pituitary adenoma
- Pituitary macroadenoma
- Pituitary microadenoma
- Prolactinoma
These terms represent different classifications or descriptions of benign pituitary tumors, all of which are appropriately coded under D35.2. The distinction between macroadenoma and microadenoma refers to the size of the tumor, with macro typically indicating tumors larger than 1 cm and micro for smaller tumors. Prolactinomas are specifically pituitary adenomas that produce excess prolactin.
Clinical Significance of D35.2 and Prolactinoma
Clinically, prolactinomas are the most common type of pituitary adenoma. They arise from the anterior pituitary gland and are characterized by the overproduction of prolactin. This excess prolactin can lead to a variety of symptoms, including:
- In women: irregular menstruation, infertility, galactorrhea (milky nipple discharge).
- In men: erectile dysfunction, decreased libido, gynecomastia (breast enlargement).
- In both sexes: headaches, visual disturbances (if the tumor is large and presses on the optic nerve), and symptoms related to hypopituitarism if other pituitary hormones are affected.
The ICD-10-CM code D35.2 is crucial for accurately documenting and classifying these cases. While D35.2 specifies a benign neoplasm, it is essential for healthcare providers to further detail the specific type of pituitary adenoma, such as prolactinoma, in the patient’s medical record for comprehensive clinical management. Diagnosis often involves blood tests to measure prolactin levels, imaging studies like MRI to visualize the pituitary gland, and clinical evaluation of symptoms.
History and Reimbursement Context of Code D35.2
The introduction of ICD-10-CM code D35.2 in 2016 marked a specific and billable code for benign pituitary neoplasms. Before this, coding might have been less specific. The consistent maintenance of this code through annual updates from 2017 to 2025 ensures its ongoing relevance and accuracy in reflecting current medical classifications.
For healthcare providers and billing departments, understanding D35.2 is paramount for submitting accurate reimbursement claims for the diagnosis and treatment of prolactinomas and other benign pituitary neoplasms. The specificity of D35.2 ensures appropriate categorization within diagnostic-related groups (MS-DRGs), influencing hospital reimbursement and healthcare statistics.
Conclusion
The ICD-10-CM diagnosis code D35.2, Benign neoplasm of pituitary gland, is the cornerstone for classifying and coding prolactinomas and other non-cancerous tumors of the pituitary gland in the US. Its consistent use and understanding are vital for accurate medical documentation, appropriate billing, and effective epidemiological tracking of these conditions. For anyone involved in medical coding, billing, or healthcare data analysis, a thorough understanding of D35.2 and its associated clinical terms is essential for navigating the complexities of the ICD-10-CM system and ensuring accurate representation of patient diagnoses.
