Hyperkalemia is one of the most common and potentially dangerous electrolyte imbalances encountered in clinical practice. For healthcare providers and medical coders, accurate coding of hyperkalemia is essential not only for proper reimbursement but also for patient safety, clinical documentation improvement (CDI), and compliance with payer guidelines.
The ICD 10 code for hyperkalemia plays a critical role in ensuring clean claim submission, avoiding payer denials, and reflecting the medical necessity of services rendered. In this guide, we’ll explore the coding, clinical, and billing dimensions of hyperkalemia, including ICD-10 code assignment, related CPT codes, treatment protocols, documentation standards, and strategies to prevent claim denials.
What is Hyperkalemia and Why is it Dangerous?
Hyperkalemia refers to an abnormally high concentration of potassium in the blood, typically defined as a serum potassium level above 5.0 mmol/L. Potassium is essential for normal cardiac and neuromuscular function, but even slight elevations can lead to life-threatening arrhythmias.
Symptoms of Hyperkalemia
Hyperkalemia may present with a range of symptoms, including:
- Muscle weakness or fatigue
- Tingling or numbness
- Nausea and vomiting
- Palpitations or irregular heartbeat
- In severe cases: ventricular fibrillation, cardiac arrest, or sudden death
Because symptoms are nonspecific, documentation of lab values and diagnostic testing is critical when assigning the ICD 10 code for hyperkalemia.
What is the ICD-10 Code for Hyperkalemia?
The official ICD-10 code for hyperkalemia is E87.5.
E87.5 – Hyperkalemia
This code is used when hyperkalemia is diagnosed based on clinical evaluation and laboratory results. It is located in Chapter 4 of the ICD-10-CM (Endocrine, Nutritional, and Metabolic Diseases).
Key Notes for Coders:
- Do not assign E87.5 for transient hyperkalemia unless the provider documents it as clinically significant.
- Always code underlying causes (e.g., chronic kidney disease, adrenal insufficiency, medication side effects) when documented.
- Sequence hyperkalemia as a secondary diagnosis if it complicates a primary condition (e.g., CKD, heart failure).
- When hyperkalemia is a manifestation of an underlying disease (e.g., CKD, heart failure, or medication-induced electrolyte imbalance), code the primary condition first unless hyperkalemia itself is the focus of care. This sequencing impacts DRG grouping and reimbursement in inpatient claims.
Where is Hyperkalemia Found in the ICD-10-CM Chapters?
The ICD 10 code for hyperkalemia (E87.5) is listed under:
- Chapter 4: Endocrine, Nutritional and Metabolic Diseases (E00–E89)
- Block: E70–E89 Metabolic Disorders
- Category: E87 Other Disorders of Fluid, Electrolyte, and Acid-Base Balance
This placement reflects that hyperkalemia is a metabolic disorder rather than a primary cardiovascular or renal disease.
What CPT Codes Are Linked to Hyperkalemia?
While the ICD-10 code for hyperkalemia captures the diagnosis, treatment and evaluation are billed under CPT/HCPCS codes. Common codes associated with hyperkalemia include:
| CPT/HCPCS Code | Description | Use Case |
|---|---|---|
| 80048 | Basic metabolic panel (calcium, total) | To measure potassium and related electrolytes |
| 36415 | Collection of venous blood by venipuncture | Lab specimen for potassium measurement |
| 93010 / 93005 | Electrocardiogram, interpretation and/or tracing | To assess arrhythmias caused by hyperkalemia |
| 96365 | IV infusion, initial, up to 1 hour | Administration of IV calcium gluconate, insulin, or other agents |
| J1815 | Injection, insulin (per 5 units) | Medication administration for potassium shifting |
| J0610 | Injection, calcium gluconate | Stabilization of cardiac membrane in acute hyperkalemia |
| 90935 / 90937 | Hemodialysis, single evaluation with or without other services | For severe hyperkalemia requiring dialysis |
Important Coding Notes:
- 96365 (IV infusion, initial up to 1 hour): This code is valid when billing for IV administration of medications such as calcium gluconate or insulin/glucose used to manage hyperkalemia. However, most payers require the infusion code to be linked with the appropriate J-code (e.g., J1815 for insulin, J0610 for calcium gluconate) to establish medical necessity. Infusion alone without a drug administration code is often denied.
- 93010 vs. 93005: Use 93010 when reporting physician interpretation only and 93005 for the tracing only. If both services (tracing + interpretation) are performed in the same encounter, bill 93000 (global service) instead. Many payers expect 93000 in office or outpatient settings unless services are clearly split.
How is Hyperkalemia Treated?
The management of hyperkalemia is based on the severity of serum potassium elevation and the presence of clinical symptoms such as cardiac arrhythmias. Accurate documentation of treatment interventions is crucial, as coders must assign the correct ICD 10 code for hyperkalemia (E87.5) and link it with appropriate CPT/HCPCS codes to support medical necessity.
While not directly part of ICD-10 coding guidelines, clinicians often categorize hyperkalemia as mild (5.1–5.9 mmol/L), moderate (6.0–6.4 mmol/L), or severe (≥6.5 mmol/L). Coders should rely on provider documentation of significance and treatment when assigning E87.5.
Mild Hyperkalemia (5.1–5.9 mmol/L)
In cases of mild hyperkalemia without EKG changes, treatment often focuses on non-invasive measures.
- Dietary modification: Reducing potassium intake by restricting high-potassium foods (bananas, oranges, potatoes).
- Medication adjustments: Discontinuation of potassium-sparing diuretics (e.g., spironolactone, amiloride) or ACE inhibitors/ARBs that elevate serum potassium.
- Documentation note for coders: Providers must clearly document both the potassium level and the medication changes for coders to link E87.5 appropriately.
Moderate Hyperkalemia (6.0–6.4 mmol/L)
Moderate cases require active interventions to shift potassium intracellularly and correct acid-base imbalances.
- IV insulin with glucose: Drives potassium into cells while preventing hypoglycemia.
- Nebulized albuterol (beta-agonist therapy): Promotes intracellular uptake of potassium.
- IV sodium bicarbonate: Used particularly in patients with concurrent metabolic acidosis.
- Documentation note for coders: Coders should ensure that physician documentation specifies both the serum potassium level and the treatment modality (e.g., IV insulin bolus, glucose infusion) to justify the ICD 10 code for hyperkalemia linked with therapeutic CPT codes.
Severe Hyperkalemia (≥6.5 mmol/L or with EKG changes)
Severe hyperkalemia is a medical emergency due to the high risk of fatal arrhythmias.
- IV calcium gluconate or calcium chloride: Stabilizes cardiac membranes and prevents arrhythmias but does not lower serum potassium.
- Loop diuretics (e.g., furosemide): Enhance renal potassium excretion in patients with preserved kidney function.
- Hemodialysis: Considered the definitive treatment, especially in patients with end-stage renal disease, severe renal impairment, or refractory hyperkalemia.
- Documentation note for coders: If dialysis is performed specifically for life-threatening hyperkalemia, the ICD 10 code for hyperkalemia (E87.5) must be reported as the principal diagnosis linked with the dialysis CPT code (e.g., 90935, 90937). This ensures both clinical justification and compliance with payer policies.
What Documentation is Required to Bill Hyperkalemia Correctly?
Accurate documentation is the cornerstone of proper coding and reimbursement when assigning the ICD 10 code for hyperkalemia (E87.5). Providers must clearly record serum potassium levels along with corresponding lab reports to establish the diagnosis. These objective findings validate the clinical decision-making process and provide payers with the medical evidence required for claim approval.
In addition to lab values, documentation should reflect the patient’s clinical signs and symptoms, such as arrhythmias, muscle weakness, or risk of cardiac arrest. The underlying etiology whether chronic kidney disease, medication-induced hyperkalemia, or adrenal insufficiency must also be captured, as it supports medical necessity and may affect secondary coding and reimbursement.
Finally, records must detail the treatment provided and the patient’s response. This includes interventions such as IV insulin with glucose, calcium gluconate, dialysis, or medication adjustments. Without this level of specificity, claims tied to E87.5 are vulnerable to denials for “insufficient documentation.” Incomplete or vague records remain one of the leading causes of revenue loss for hyperkalemia-related services.
Why Are Hyperkalemia Claims Denied and How Can You Prevent It?
Common denial reasons include:
- Lack of medical necessity (labs not attached, symptoms missing)
- Improper code linkage (E87.5 without related CPT codes)
- Missing underlying diagnosis codes (e.g., CKD not coded)
- Absence of lab confirmation
Prevention Tips:
- Always attach potassium lab results.
- Link ICD-10 with correct CPT procedures.
- Capture comorbidities to demonstrate necessity.
- Follow payer-specific LCD/NCD policies.
How Pro-MBS Helps Providers Code Hyperkalemia Accurately
We recognize the compliance challenges and revenue risks providers face when coding metabolic disorders such as hyperkalemia. Our certified medical billers and coders ensure the accurate assignment of the ICD 10 code for hyperkalemia (E87.5) and proper linkage with CPT/HCPCS codes. Every claim is reviewed against supporting documentation lab results, physician notes, and treatment details to confirm medical necessity and maintain audit readiness.
We also apply payer-specific rules to minimize denials and improve first-pass acceptance rates, while offering dedicated denial management support if claims are rejected for insufficient medical necessity. By partnering with Pro-MBS, providers benefit from cleaner claims, faster reimbursements, and reduced compliance risks, allowing them to focus more on patient care and less on revenue cycle obstacles.
