Nutrition Counseling ICD-10 Codes for Dietitians

Last Updated: 11/13/24

What is an ICD-10 Code?

An ICD-10 code is a type of medical code used to represent diagnoses, symptoms and procedures. Instead of writing “diabetes” on an insurance claim form, a corresponding ICD-10 code, such as E11.9, is used instead.

Some examples of ICD-10 codes with their corresponding descriptions include:

E11.9 -Type 2 diabetes mellitus without complications
R51.9 – Headache, unspecified
Z00.00 – Encounter for general adult adult medical examination without abnormal findings

ICD-10 stands for International Classification of Diseases, 10th edition. It was designed by the World Health Organization (WHO) and then adapted for the United States by the Centers for Medicare & Medicaid Services (CMS) and the National Center for Health Statistics (NCHS).

Why are ICD-10 Codes Used?

When it comes to insurance billing, codes create a universal language which makes the billing process simpler and more standardized. Just like CPT codes are used to describe the medical services provided, ICD-10 codes are used to describe the diagnoses treated.

In addition to streamlining the billing process, ICD-10 codes are also used to collect data for quality measurement, resource utilization, and monitoring outcomes.

Where do ICD-10 Codes Go?

The ICD-10 code(s) go in box 21 on the CMS-1500 form. Note that you should not include the decimal point of the ICD-10 code.

How Many ICD-10 Codes Can Be Listed?

Box 21 on the CMS-1500 form has space for diagnosis codes A through L, so up to 12 codes can be listed. However, it is unnecessary for dietitians to list this many codes. For most claims, one to two ICD-10 codes will be needed.

Can Dietitians Use ICD-10 Codes?

Dietitians need to use ICD-10 codes to bill insurance companies for nutrition counseling services. If a claim does not have any ICD-10 code(s) listed, it will be denied.

However, diagnosing medical conditions is not in a dietitian’s scope of practice, so using ICD-10 codes has to be done carefully.

Documentation of Medical Codes

Dietitians are able to use medical codes (e.g. diabetes, hyperlipidemia, hypertension) for billing. For example, if you are providing medical nutrition therapy for diabetes, using a diabetes diagnosis would be the best fit.

However, since dietitians are unable to diagnose this medical condition, this code will have to be documented by a different healthcare provider that can diagnose, such as a physician. Therefore, either medical records or a referral with the corresponding ICD-10 code will need to be collected in order to use it.

Even if the patient tells you they have diabetes, and you see paperwork from their physician stating they have diabetes, this is not enough. The actual code needs to be documented somewhere. If you simply ask the doctor’s office for a most recent progress note, the diagnosis codes will most likely be on there, as most electronic health records automatically include ICD-10 codes next to diagnoses.

Once in a while, at my office, we are unable to get written documentation of the ICD-10 code we need to bill with. In this case, we call the provider office to get information over the phone. We then document the verbal information provided in the patient’s chart along with the name of the staff member. Best practice is to get written documentation rather than verbal.

Z Codes

Z codes are described as “factors influencing health status and contact with health services.” Since these are not diagnostic codes, dietitians can use these without documentation. Some examples of Z codes include:

Z71.3 – Dietary counseling and surveillance
Z68.30 – BMI 30.0-30.9, adult
Z59.41 – Food insecurity

ICD-10 Codes Related to Dietary Counseling

There are thousands and thousands of ICD-10 codes, many of which can apply to dietitians. Below you can find several lists of ICD-10 codes dietitians are using. Note that these lists are not exhaustive.

Z71.3

Dietary counseling and surveillance is code Z71.3 and is often used by dietitians, for a variety of reasons. This code is appropriate if a dietitian is meeting with something in which there is no specific diagnosis. So if the patient is a healthy individual, this code is fair game. Also, for some insurance companies to cover nutrition counseling as a preventive visit, Z71.3 must be the first and sometimes only code used.

BMI Z Codes

Z68.1 – BMI 19.9 or less, adult
Z68.20 – BMI 20.0-20.9, adult
Z68.21 – BMI 21.0-21.9, adult
Z68.22 – BMI 22.0-22.9, adult
Z68.23 – BMI 23.0-23.9, adult
Z68.24 – BMI 24.0-24.9, adult
Z68.25 – BMI 25.0-25.9, adult
Z68.26 – BMI 26.0-26.9, adult
Z68.27 – BMI 27.0-27.9, adult
Z68.28 – BMI 28.0-28.9, adult
Z68.29 – BMI 29.0-29.9, adult
Z68.30 – BMI 30.0-30.9, adult
Z68.31 – BMI 31.0-31.9, adult
Z68.32 – BMI 32.0-32.9, adult
Z68.33 – BMI 33.0-33.9, adult
Z68.34 – BMI 34.0-34.9, adult
Z68.35 – BMI 35.0-35.9, adult
Z68.36 – BMI 36.0-36.9, adult
Z68.37 – BMI 37.0-37.9, adult
Z68.38 – BMI 38.0-38.9, adult
Z68.39 – BMI 39.0-39.9, adult
Z68.41 – BMI 40.0-44.9, adult
Z68.42 – BMI 45.0-49.9, adult
Z68-43 – BMI 50.0-59.9, adult
Z68.44 – BMI 60.0-69.9, adult
Z68.45 – BMI > 70.0, adult

Pediatric BMI Codes

Z68.51 – BMI pediatric, less than 5th percentile for age
Z68.52 – BMI pediatric, 5th percentile to less than 85th percentile for age
Z68.53 – BMI pediatric, 85th percentile to less than 95th percentile for age
Z68.54 – BMI pediatric, greater than or equal to 95th percentile for age
Z68.55 – BMI pediatric, 120% of the 95th percentile for age to less than 140% of the 95th percentile for age
Z68.56 – BMI pediatric, greater than or equal to 140% of the 95th percentile for age

Other Z Codes of Interest

Z48.22 – Encounter for aftercare following kidney transplant
Z59.01 – Sheltered homelessness
Z59.02 – Unsheltered homelessness
Z59.41 – Food insecurity
Z59.48 – Other specified lack of adequate food
Z72.0 – Tobacco use
Z72.3 – Lack of physical exercise
Z72.4 – Inappropriate diet and eating habits
Z82.3 – Family history of stroke
Z82.41 – Family history of sudden cardiac death
Z82.49 – Family history of ischemic heart disease and other diseases of the circulatory system
Z98.84 – Bariatric surgery status

Medical Codes

Weight Management ICD-10 Codes

E66.01 – Morbid (severe) obesity due to excess calories
E66.09 – Other obesity due to excess calories
E66.1 – Drug induced obesity
E66.2 – Morbid (severe) obesity with alveolar hypoventilation
E66.3 – Overweight
E66.811 – Obesity, class 1
E66.812 – Obesity, class 2
E66.813 – Obesity, class 3
E66.89 – Other obesity not elsewhere classified
E88.82 – Obesity due to disruption of MC4R pathway
E66.9 – Obesity, unspecified
R63.4 – Abnormal weight loss
R63.5 – Abnormal weight gain
R63.6 – Underweight

Eating Disorder ICD-10 Codes

F50.00 – Anorexia nervosa, unspecified
F50.010 – Anorexia nervosa, restricting type, mild
F50.014 – Anorexia nervosa, restricting type, in remission
F50.019 – Anorexia nervosa, restricting type, unspecified
F50.020 – Anorexia nervosa, binge eating/purging type, mild
F50.024 – Anorexia nervosa, binge eating/purging type, in remission
F50.029 – Anorexia nervosa, binge eating/purging type, unspecified
F50.20 – Bulimia nervosa, unspecified
F50.21 – Bulimia nervosa, mild
F50.25 – Bulimia nervosa, in remission
F50.810 – Binge eating disorder, mild
F50.814 – Binge eating disorder, in remission
F50.819 – Binge eating disorder, unspecified
F50.82 – Avoidant/restrictive food intake disorder
F50.89 – Other specified eating disorder
F50.9 – Eating disorder, unspecified

Diabetes ICD-10 Codes

E08.9 – Diabetes mellitus related to underlying condition without complications
E09.9 – Drug or chemical induced diabetes mellitus without complications
E10.10 – Type 1 diabetes mellitus with ketoacidosis without coma
E10.21 – Type 1 diabetes mellitus with diabetic nephropathy
E10.22 – Type 1 diabetes mellitus with diabetic chronic kidney disease
E10.319 – Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema
E10.39 – Type 1 diabetes mellitus with other diabetic ophthalmic complication
E10.40 – Type 1 diabetes mellitus with diabetic neuropathy, unspecified
E10.649 – Type 1 diabetes with hypoglycemia without coma
E10.65 – Type 1 diabetes with hyperglycemia
E10.8 – Type 1 diabetes mellitus with unspecified complications
E10.9 – Type 1 diabetes mellitus without complications
E11.10 – Type 2 diabetes mellitus with ketoacidosis without coma
E11.21 – Type 2 diabetes mellitus with diabetic nephropathy
E11.22 – Type 2 diabetes mellitus with diabetic chronic kidney disease
E11.319 – Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema
E11.39 – Type 2 diabetes mellitus with other diabetic ophthalmic complication
E11.40 – Type 2 diabetes mellitus with diabetic neuropathy, unspecified
E11.649 – Type 2 diabetes with hypoglycemia without coma
E11.65 – Type 2 diabetes with hyperglycemia
E11.8 – Type 2 diabetes mellitus with unspecified complications
E11.9 – Type 2 diabetes mellitus without complications
E13.9 – Other specified diabetes mellitus without complications
O24.01 – Pre-existing diabetes mellitus, type 1, in pregnancy
O24.11 – Pre-existing diabetes mellitus, type 2, in pregnancy
O24.410 – Gestational diabetes mellitus, diet-controlled
O24.414 – Gestational diabetes mellitus, insulin-controlled

Renal Disease ICD-10 Codes

I12.0 – Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
I12.9 – Hypertensive chronic kidney disease with stage 1 through 4 chronic kidney disease, or unspecified kidney disease
N20.0 – Calculus of kidney
N18.1 – Chronic kidney disease, stage 1
N18.2 – Chronic kidney disease, stage 2
N18.31 – Chronic kidney disease, stage 3a
N18.32 – Chronic kidney disease, stage 3b
N18.5 – Chronic kidney disease, stage 5
N18.4 – Chronic kidney disease, stage 4
Z48.22 – Encounter for aftercare following kidney transplant

Cardiometabolic ICD-10 Codes

E78.0 – Pure hypercholesterolemia
E78.1 – Pure hyperglyceridemia
E78.2 – Mixed hyperlipidemia
E78.3 – Hyperchylomicronemia
E78.4 – Other hyperlipidemia
E78.5 – Hyperlipidemia, unspecified
E78.8 – Other disorders of lipoprotein metabolism
E78.9 – Disorder of lipoprotein metabolism, unspecified
E88.810 – Metabolic syndrome
E88.818 – Other insulin resistance
E88.819 – Insulin resistance, unspecified
I10 – Essential (primary) hypertension
I11.0 – Hypertensive heart disease with (congestive) heart failure
I11.9 – Hypertensive heart disease without (congestive) heart failure
I12.0 – Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
I12.9 – Hypertensive chronic kidney disease with stage 1 through 4 chronic kidney disease, or unspecified kidney disease
I25.10 – Atherosclerotic heart disease of native coronary artery without angina pectoris
I25.2 – Old myocardial infarction

Gastrointestinal ICD-10 Codes

E73.0 – Congenital lactase deficiency
E73.1 – Secondary lactase deficiency
E73.8 – Other lactose intolerance
E73.9 – Lactose intolerance, unspecified
K21.0 – Gastroesophageal reflux disease with esophagitis
K21.9 – Gastroesophageal reflux disease without esophagitis
K25.3 – Acute gastric ulcer without hemorrhage or perforation
K25.7 – Chronic gastric ulcer without hemorrhage or perforation
K27.3 – Acute peptic ulcer, site unspecified, without hemorrhage or perforation
K29.2 – Alcoholic gastritis
K29.5 – Unspecified chronic gastritis
K29.7 – Gastritis, unspecified
K44.9 – Diaphragmatic hernia without obstruction or gangrene
K50.0 – Crohn’s disease of small intestine
K50.1 – Crohn’s disease of large intestine
K50.8 – Crohn’s disease of both small and large intestine
K50.9 – Crohn’ disease, unspecified
K51.9 – Unspecified ulcerative colitis without complications
K57.01 – Diverticulitis of small intestine with perforation and abscess with bleeding
K57.30 – Diverticulosis of large intestine without perforation or abscess without bleeding
K58.0 – Irritable bowel syndrome with diarrhea
K58.1 – Irritable bowel syndrome with constipation
K58.2 – Mixed irritable bowel syndrome
K59.00 – Unspecified constipation
K70.3 – Alcoholic cirrhosis of liver
K76.0 – Fatty (change of) liver, not elsewhere classified
K76.9 – Liver disease, unspecified
K86.0 – Alcohol-induced chronic pancreatitis
K86.1 – Other chronic pancreatitis
K90.0 – Celiac disease
K52.2 – Allergic and dietetic gastroenteritis and colitis
R74.01 – Abnormal serum enzyme level, unspecified

Endocrine ICD-10 Codes

E03.9 – Hypothyroidism, unspecified
E05.90 – Thyrotoxicosis, unspecified
E16.0 – Drug-induced hypoglycemia without coma
E16.1 – Other hypoglycemia
E16.2 – Hypoglycemia, unspecified
E16.2 – Hypoglycemia, unspecified
E16.A1 – Hypoglycemia level 1
E16.A2 – Hypoglycemia level 2
E16.A3 – Hypoglycemia level 3
E28.2 – Polycystic ovarian syndrome
R73.01 – Impaired fasting glucose
R73.02 – Impaired glucose tolerance test (oral)
R73.03 – Pre-diabetes
R73.09 – Other abnormal glucose
R73.9 – Hyperglycemia, unspecified

Pregnancy ICD-10 Codes

O14.00 – Mild to moderate pre-eclampsia, unspecified trimester
O14.10 – Severe pre-eclampsia, unspecified trimester
O14.90 – Unspecified pre-eclampsia, unspecified trimester
O21.0 – Mild hyperemesis gravidarum
O21.1 – Hyperemesis gravidarum with metabolic disturbance
O21.2 – Late vomiting of pregnancy
O24.01 – Pre-existing diabetes mellitus, type 1, in pregnancy
O24.11 – Pre-existing diabetes mellitus, type 2, in pregnancy
O24.410 – Gestational diabetes mellitus, diet-controlled
O24.414 – Gestational diabetes mellitus, insulin-controlled
O26.00 – Excessive weight gain in pregnancy, unspecified trimester
O26.10 – Low weight gain in pregnancy, unspecified trimester
O99.210 – Obesity complicating pregnancy, unspecified trimester

Disorders of Blood ICD-10 Codes

D50.8 – Other iron deficiency anemias
D50.9 – Iron deficiency anemia, unspecified
D51.3 – Other dietary vitamin B12 deficiency anemia
D52.0 – Dietary folate anemia
D53.0 – Protein deficiency anemia
D53.9 – Nutrition anemia, unspecified
D64.9 – Anemia, unspecified

Malnutrition ICD-10 Codes

E40 – Kwashiorkor
E41 – Nutritional marasmus
E42 – Marasmic kwashiorkor
E43 – Unspecified severe protein-calorie malnutrition
E44.0 – Moderate protein-calorie malnutrition
E44.1 – Mild protein-calorie malnutrition
E45 – Retarded development following protein-calorie malnutrition
E46 – Unspecified protein-calorie malnutrition

Miscellaneous Medical ICD-10 Codes Related to Nutrition

B20 – HIV disease
E84.0 – Cystic fibrosis with pulmonary manifestations
E84.9 – Cystic fibrosis, unspecified
G47.30 – Sleep apnea, unspecified
G47.33 – Obstructive sleep apnea
M81.0 – Age-related osteoporosis without current pathological fracture
M81.8 – Other osteoporosis without current pathological fracture
M1A.30 – Chronic gout due to renal impairment, unspecified site
M1A.9XX0 – Chronic gout, unspecified, without tophus
M10.30 – Gout due to renal impairment, unspecified site
M10.40 – Other secondary gout, unspecified site
M10.9 – Gout, unspecified
Q87.11 – Prader-Willi syndrome

Summary of Diagnosis Codes for Nutritional Counseling

ICD-10 codes are the standardized shorthand of communicating to the insurance companies what disease states or conditions you saw the patient for. Make sure to get documentation of medical diagnosis codes, and keep the list short and sweet. If you are manually entering or writing out the ICD-10 codes, make sure to not include the decimal point.