ED Coding and Reimbursement Alert

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.