ED Coding and Reimbursement Alert

Question: Encounter notes indicate that a patient with uncontrolled type II diabetes had an insulin overdose. The patient also reported having nausea and a brief blackout prior to reporting to the ED. Is 962.3 the correct diagnosis code for the insulin reaction?

Illinois Subscriber

Answer: Maybe. Your overdose code choice will depend on whether the patient took her medication correctly. Check the encounter notes to find out what caused the patient's insulin reaction. If the patient took more than the prescribed amount of insulin, then you would report:

- 962.3 (Poisoning by hormones and synthetic substitutes; insulins and antidiabetic agents) for the overdose.

- 780.2 (Syncope and collapse) for the blackout

- 787.02 (Nausea alone) for the nausea

- 250.02 (Diabetes mellitus without mention of complication; type II or unspecified type, uncontrolled) for the diabetes

- E858.0 (Accidental poisoning by other drugs; hormones and synthetic substitutes) to represent the cause of the patient's injuries.

However, if notes indicate that the patient had the adverse reaction but took the correct amount of insulin, you would not report 962.3. In these cases, you would report the following:

- 780.2 and 787.02 to represent the patient's presenting symptoms

- 250.xx for the diabetes

- E932.3 (Hormones and synthetic substitutes; insulins and antidiabetic agents) to show that the patient took the correct dosage but still had an overdose.