Skip to main content

E22.1 ICD-10-CM Code: Hyperprolactinemia

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
7 Excludes1 · 1 use-additional code
Risk adjustment
CMS-HCC V22 category 23 · RxHCC V08 category 43

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 643 — ENDOCRINE DISORDERS WITH MCC (MDC 10)
  • MS-DRG 644 — ENDOCRINE DISORDERS WITH CC (MDC 10)
  • MS-DRG 645 — ENDOCRINE DISORDERS WITHOUT CC/MCC (MDC 10)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for E22.1 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on E22.1 itself; “inherited from” names the category or block whose note applies here.

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

Coder workflow for E22.1

MedCoder structured workflow — derived from this code’s own official record

Before you code E22.1

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with E22.1. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in E22.1’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewE24, E24.1, E27.0, E24.0, E05.8, N64.3

Consider E22.1. Then work the Use Additional Code note, and confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.

Official instructions as workflow

  • Excludes1 — check before selecting E22.1(7 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with E22.1: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareE24, E24.1, E27.0, E24.0, E05.8, N64.3

    See the official tabular notes · Guidelines I.A.12.a

  • Use Additional Code — after identifying E22.1(1 note)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with E22.1 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition E22.1 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewE24, E24.1, E27.0, E24.0, E05.8, N64.3

Documentation: A condition the Use Additional Code note names is documented.

Coding question: Is a second code reported with E22.1?

Path: Review the Use Additional Code note and the code it names.

Reason: The additional code is reported when the record documents the condition; a conditional instruction applies only when its condition is met (Guidelines I.A.13).

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Hyperprolactinemia is a billable ICD-10-CM diagnosis code (E22.1).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (1)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Verify Before Coding

  • CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name E22.1 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Code First instruction: G63 — Polyneuropathy in diseases classified elsewhere (via E22.-).

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 4 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 3 MS-DRGs: DRG 643 (MDC 10), DRG 644 (MDC 10), DRG 645 (MDC 10).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):END013 — Pituitary disorders (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

E22.2 — Syndrome of inappropriate secretion of antidiuretic hormone, E22.8 — Other hyperfunction of pituitary gland, E22.9 — Hyperfunction of pituitary gland, unspecified

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Pituitary disorders).

E22.0 — Acromegaly and pituitary gigantism, E22.2 — Syndrome of inappropriate secretion of antidiuretic hormone, E22.8 — Other hyperfunction of pituitary gland, E22.9 — Hyperfunction of pituitary gland, unspecified, E23.0 — Hypopituitarism, E23.1 — Drug-induced hypopituitarism, E23.2 — Diabetes insipidus, E23.3 — Hypothalamic dysfunction, not elsewhere classified, E23.6 — Other disorders of pituitary gland, E23.7 — Disorder of pituitary gland, unspecified, E24.0 — Pituitary-dependent Cushing's disease, G11.5 — Hypomyelination - hypogonadotropic hypogonadism - hypodontia

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Blood Glucose Test, Thyroid Stimulating Hormone (TSH)

Contextual Map

Every relationship of E22.1 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run E22.1 with these 9 related codes in Claim Check

Hierarchy

Use Additional Code (15)

Referenced by Code First instructions

Clinical classification (CCSR)

MS-DRG Grouper

  • CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2026
  • DRG 643 — ENDOCRINE DISORDERS WITH MCC[MS-DRG]: “ENDOCRINE DISORDERS WITH MCC (MDC 10)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
  • DRG 644 — ENDOCRINE DISORDERS WITH CC[MS-DRG]: “ENDOCRINE DISORDERS WITH CC (MDC 10)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
  • DRG 645 — ENDOCRINE DISORDERS WITHOUT CC/MCC[MS-DRG]: “ENDOCRINE DISORDERS WITHOUT CC/MCC (MDC 10)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

  • MDC 10 — Endocrine, Nutritional and Metabolic Diseases and Disorders[MDC crossing]: “Endocrine, Nutritional and Metabolic Diseases and Disorders — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 5,008 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Hyperprolactinemia[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "E22.1 — Hyperprolactinemia." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/e22.1-hyperprolactinemia

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Hyperprolactinemia

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to E22.1 in its code family, with their registry titles.

View all codes in the E22 family