ED Coding and Reimbursement Alert

Reader Questions:

Coma Code Choice Comes After Diabetes Check

Question: A patient in a hypoglycemic coma reports to the ED via ambulance. The ED physician provides 39 minutes of critical care to stabilize the patient. What is the best ICD-9 code for this patient? Nebraska Subscriber Answer: It depends on if the patient is in a diabetic hypoglycemic coma, or is in a hypoglycemic coma. According to the ICD-9 definition of diabetic hypoglycemic coma, the condition is "caused by hyperglycemia or hypoglycemia as complications of diabetes." This condition is also known as "diabetic coma (with ketoacidosis)," "diabetic hypoglycemic coma," and "insulin coma NOS." So if the patient's condition was caused by diabetes, you would report the following: - 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the critical care - 250.3x (Diabetes with other coma) appended to 99291 to represent the patient's condition. If, however, the patient is in a hypoglycemic coma without diabetes, diagnosis coding will change. According to ICD-9, a hypoglycemic coma is "induced by low blood sugar in non-diabetic patient." So if the patient's coma was not caused by diabetes, you would report 99291 for the critical care, with 251.0 (Hypoglycemic coma) appended to describe the coma.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more