ICD-9 Code 268.0

Rickets, active

  1. ICD-9 Index
  2. Chapter: 240–279
  3. Section: 260-269
  4. Block: 268 Vitamin D deficiency
  5. 268.0 - Rickets, active

Not Valid for Submission

268.0 is a legacy non-billable code used to specify a medical diagnosis of rickets, active. This code was replaced on September 30, 2015 by its ICD-10 equivalent.

ICD-9: 268.0
Short Description:Rickets, active
Long Description:Rickets, active

Convert 268.0 to ICD-10

The following crosswalk between ICD-9 to ICD-10 is based based on the General Equivalence Mappings (GEMS) information:

Code Classification

  • Endocrine, nutritional and metabolic diseases, and immunity disorders (240–279)
    • Nutritional deficiencies (260-269)
      • 268 Vitamin D deficiency

Information for Medical Professionals

Index to Diseases and Injuries

References found for the code 268.0 in the Index of Diseases and Injuries:


Information for Patients


Rickets

Rickets causes soft, weak bones in children. It usually occurs when they do not get enough vitamin D, which helps growing bones absorb the minerals calcium and phosphorous. It can also happen when calcium or phosphorus levels are too low.

Your child might not get enough vitamin D if he or she:

  • Has dark skin
  • Spends too little time outside
  • Has on sunscreen all the time when out of doors
  • Doesn't eat foods containing vitamin D because of lactose intolerance or a strict vegetarian diet
  • Is breastfed without receiving vitamin D supplements
  • Can't make or use vitamin D because of a medical disorder such as celiac disease

In addition to dietary rickets, children can get an inherited form of the disease. Symptoms include bone pain or tenderness, impaired growth, and deformities of the bones and teeth. Your child's doctor uses lab and imaging tests to make the diagnosis. Treatment is replacing the calcium, phosphorus, or vitamin D that are lacking in the diet. Rickets is rare in the United States.


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Vitamin D Deficiency

What is vitamin D deficiency?

Vitamin D deficiency means that you are not getting enough vitamin D to stay healthy.

Why do I need vitamin D and how do I get it?

Vitamin D helps your body absorb calcium. Calcium is one of the main building blocks of bone. Vitamin D also has a role in your nervous, muscle, and immune systems.

You can get vitamin D in three ways: through your skin, from your diet, and from supplements. Your body forms vitamin D naturally after exposure to sunlight. But too much sun exposure can lead to skin aging and skin cancer, so many people try to get their vitamin D from other sources.

How much vitamin D do I need?

The amount of vitamin D you need each day depends on your age. The recommended amounts, in international units (IU), are:

  • Birth to 12 months: 400 IU
  • Children 1-13 years: 600 IU
  • Teens 14-18 years: 600 IU
  • Adults 19-70 years: 600 IU
  • Adults 71 years and older: 800 IU
  • Pregnant and breastfeeding women: 600 IU

People at high risk of vitamin D deficiency may need more. Check with your health care provider about how much you need.

What causes vitamin D deficiency?

You can become deficient in vitamin D for different reasons:

  • You don't get enough vitamin D in your diet
  • You don't absorb enough vitamin D from food (a malabsorption problem)
  • You don't get enough exposure to sunlight.
  • Your liver or kidneys cannot convert vitamin D to its active form in the body.
  • You take medicines that interfere with your body's ability to convert or absorb vitamin D

Who is at risk of vitamin D deficiency?

Some people are at higher risk of vitamin D deficiency:

  • Breastfed infants, because human milk is a poor source of vitamin D. If you are breastfeeding, give your infant a supplement of 400 IU of vitamin D every day.
  • Older adults, because your skin doesn't make vitamin D when exposed to sunlight as efficiently as when you were young, and your kidneys are less able to convert vitamin D to its active form.
  • People with dark skin, which has less ability to produce vitamin D from the sun.
  • People with disorders such as Crohn's disease or celiac disease who don't handle fat properly, because vitamin D needs fat to be absorbed.
  • People who have obesity, because their body fat binds to some vitamin D and prevents it from getting into the blood.
  • People who have had gastric bypass surgery
  • People with osteoporosis
  • People with chronic kidney or liver disease.
  • People with hyperparathyroidism (too much of a hormone that controls the body's calcium level)
  • People with sarcoidosis, tuberculosis, histoplasmosis, or other granulomatous disease (disease with granulomas, collections of cells caused by chronic inflammation)
  • People with some lymphomas, a type of cancer.
  • People who take medicines that affect vitamin D metabolism, such as cholestyramine (a cholesterol drug), anti-seizure drugs, glucocorticoids, antifungal drugs, and HIV/AIDS medicines.

Talk with your health care provider if you are at risk for vitamin D deficiency. There is a blood test which can measure how much vitamin D is in your body.

What problems does vitamin D deficiency cause?

Vitamin D deficiency can lead to a loss of bone density, which can contribute to osteoporosis and fractures (broken bones).

Severe vitamin D deficiency can also lead to other diseases. In children, it can cause rickets. Rickets is a rare disease that causes the bones to become soft and bend. African American infants and children are at higher risk of getting rickets. In adults, severe vitamin D deficiency leads to osteomalacia. Osteomalacia causes weak bones, bone pain, and muscle weakness.

Researchers are studying vitamin D for its possible connections to several medical conditions, including diabetes, high blood pressure, cancer, and autoimmune conditions such as multiple sclerosis. They need to do more research before they can understand the effects of vitamin D on these conditions.

How can I get more vitamin D?

There are a few foods that naturally have some vitamin D:

  • Fatty fish such as salmon, tuna, and mackerel
  • Beef liver
  • Cheese
  • Mushrooms
  • Egg yolks

You can also get vitamin D from fortified foods. You can check the food labels to find out whether a food has vitamin D. Foods that often have added vitamin D include:

  • Milk
  • Breakfast cereals
  • Orange juice
  • Other dairy products, such as yogurt
  • Soy drinks

Vitamin D is in many multivitamins. There are also vitamin D supplements, both in pills and a liquid for babies.

If you have vitamin D deficiency, the treatment is with supplements. Check with your health care provider about how much you need to take, how often you need to take it, and how long you need to take it.

Can too much vitamin D be harmful?

Getting too much vitamin D (known as vitamin D toxicity) can be harmful. Signs of toxicity include nausea, vomiting, poor appetite, constipation, weakness, and weight loss. Excess vitamin D can also damage the kidneys. Too much vitamin D also raises the level of calcium in your blood. High levels of blood calcium (hypercalcemia) can cause confusion, disorientation, and problems with heart rhythm.

Most cases of vitamin D toxicity happen when someone overuses vitamin D supplements. Excessive sun exposure doesn't cause vitamin D poisoning because the body limits the amount of this vitamin it produces.


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ICD-9 Footnotes

General Equivalence Map Definitions
The ICD-9 and ICD-10 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.

  • Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
  • No Map Flag - The no map flag indicates that a code in the source system is not linked to any code in the target system.
  • Combination Flag - The combination flag indicates that more than one code in the target system is required to satisfy the full equivalent meaning of a code in the source system.

Index of Diseases and Injuries Definitions

  • And - The word "and" should be interpreted to mean either "and" or "or" when it appears in a title.
  • Code also note - A "code also" note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction.
  • Code first - Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.
  • Type 1 Excludes Notes - A type 1 Excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
  • Type 2 Excludes Notes - A type 2 Excludes note represents "Not included here". An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.
  • Includes Notes - This note appears immediately under a three character code title to further define, or give examples of, the content of the category.
  • Inclusion terms - List of terms is included under some codes. These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
  • NEC "Not elsewhere classifiable" - This abbreviation in the Alphabetic Index represents "other specified". When a specific code is not available for a condition, the Alphabetic Index directs the coder to the "other specified” code in the Tabular List.
  • NOS "Not otherwise specified" - This abbreviation is the equivalent of unspecified.
  • See - The "see" instruction following a main term in the Alphabetic Index indicates that another term should be referenced. It is necessary to go to the main term referenced with the "see" note to locate the correct code.
  • See Also - A "see also" instruction following a main term in the Alphabetic Index instructs that there is another main term that may also be referenced that may provide additional Alphabetic Index entries that may be useful. It is not necessary to follow the "see also" note when the original main term provides the necessary code.
  • 7th Characters - Certain ICD-10-CM categories have applicable 7th characters. The applicable 7th character is required for all codes within the category, or as the notes in the Tabular List instruct. The 7th character must always be the 7th character in the data field. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters.
  • With - The word "with" should be interpreted to mean "associated with" or "due to" when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. The word "with" in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order.

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