Home Health ICD-9/ICD-10 Alert

Question: We have a question regarding the use of 250.80 (Diabetes with other specified manifestations; type II or unspecified type, not stated as uncontrolled) for a patient with hypoglycemia. Your latest issue (Vol 8, no. 9) discusses the use of this code for hypoglycemia, but we don't understand how a patient can be hypoglycemic without exhibiting out of control diabetes.

I see how neurologic or circulatory problems are manifestations of diabetes, but I do not understand how hypoglycemia is a manifestation of the disease. I believe it indicates out of control diabetes for which we would list a fifth digit 2 or 3. At the very least I think we would want to code a type II hypoglycemic patient with 250.82 (Diabetes with other specified manifestations;type II or unspecified type, uncontrolled) rather than 250.80.

California Subscriber

Answer: Diabetic hypoglycemia is not considered a manifestation. It is considered a metabolic complication, just like ketoacidosis or hyperosmolarity. The hypoglycemia may be caused by insulin, exercise, diet, etc.

However, the ICD-9 diagnosis code for hypoglycemia is 250.8x (Diabetes with other specified manifestations). When you look up "Hypoglycemia; diabetic" in the alphabetic index of your coding manual, you're directed to this code. And you'll see that "Diabetic hypoglycemia NOS" is included in this code in the tabular list.

Diabetic hypoglycemia is not automatically considered uncontrolled. The physician must document "uncontrolled" or "out of control" before you can code the diabetes as uncontrolled.

The Coding Clinic mentions only one diabetes diagnosis that can be assumed to be uncontrolled without physician documentation -- diabetes with ketoacidosis (250.13). Diabetes with ketoacidosis is assumed to be uncontrolled and Type 1 unless the physician specifies otherwise.