ICD Code E88.81

ICD code E88.81 is metabolic syndrome, a cluster of conditions—including high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels—that increase the risk of heart disease, stroke, and diabetes.

1. Central obesity (increased waist circumference specific to population and country)

2. Elevated triglycerides (≥150 mg/dL) or receiving treatment for elevated triglycerides

3. Reduced HDL cholesterol (<40 mg/dL in men, <50 mg/dL in women) or receiving treatment for reduced HDL cholesterol

4. Elevated blood pressure (systolic ≥130 mm Hg or diastolic ≥85 mm Hg) or receiving antihypertensive treatment

5. Elevated fasting glucose (≥100 mg/dL) or receiving treatment for elevated glucose

Use the code when a patient meets at least three of the above criteria.

Relevant CPT codes that may be used to treat ICD code E88.81 include:

- 99202–99215 (Evaluation and Management services, new and established patients)

- 83036 (Hemoglobin A1c)

- 80061 (Lipid panel)

- 84443 (Thyroid stimulating hormone, TSH)

- 82947 (Glucose; quantitative, blood)

- 83036 (Glycated hemoglobin)

- 36415 (Collection of venous blood by venipuncture)

- 99401–99404 (Preventive medicine counseling)

- 97802–97804 (Medical nutrition therapy)

CPT code selection should be based on the specific services rendered for ICD code E88.81.

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