Question: One of our endocrinologists wants a diagnosis code for "hypoglycemic unawareness." The best I can come up with is 250.8x. Is there a better code to use?
Colorado Subscriber
Answer: Hypoglycemic unawareness is a condition that usually occurs in patients who have had diabetes for a long time. The body's normal response to hypoglycemia (low blood sugar) is to release adrenaline, which triggers certain identifiable symptoms such as sweating, shaking, a queasy stomach and feeling light-headed or anxious. Diabetic people rely on these telltale symptoms to alert them when their glucose levels are low.
However, after many years of diabetes, a diabetic patient's response to low blood sugar can be dulled and the body may not produce adrenaline to trigger the telltale symptoms of hypoglycemia. This means a patient can be unaware that he is becoming hypoglycemic - a very dangerous situation.
Diagnosis code 250.8x (Diabetes with other specified manifestations) does list diabetic hypoglycemia and hypoglycemic shock as conditions you could report with this code. Using 250.8x to report hypoglycemic unawareness would be appropriate because it indicates the diabetic hypoglycemia. However, this code does not account for the dulled nervous response that causes the "unawareness."
Many times a form of neuropathy is causing the patient's dulled response to hypoglycemia. Nerve damage from diabetes can be internal as well as external, harming even the body's automatic responses. If this is the case, 250.6x (Diabetes with neurological manifestations) would also be an appropriate code to use.
Remember: Neuropathy is not always the cause of hypoglycemic unawareness, so you should check with your physician first to determine if 250.6 would be an appropriate code.
- The answers to You Be The Coder and the Reader Questions were provided and/or reviewed by Anita M. Carr, CPC, business office manager and assistant practice manager at Endocrine and Diabetes Associates in Louisville, Ky.; Anthony Azzi, MD, a clinical endocrinologist with Raleigh Endocrine Associates in Raleigh, N.C.; and Judy Richardson, MSA, RN, CCS-P, senior consultant with Hill & Associates in Wilmington, N.C.
