Primary Care Coding Alert

Question: A diabetes patient who just started using insulin presented with blurred vision and dizziness. The family physician found that he had an adverse reaction to the insulin. Should I code for poisoning or for adverse reaction?

New Hampshire Subscriber

Answer: The diagnosis code depends on whether the patient took the insulin correctly or incorrectly (e.g., overdose). If the patient took the insulin according to the physician's instructions but had an adverse reaction, you should code for the symptoms. Report 780.4 (Dizziness and giddiness) and 368.8 (Other specified visual disturbances; blurred vision NOS). Also include E932.3 (Drugs, medicinal and biological substances causing adverse effects in therapeutic use; hormones and synthetic substitutes; insulins and antidiabetic agents).

However, if the patient took the insulin in a way contrary to the prescription, use 962.3 (Poisoning by hormones and synthetic substitutes; insulins and antidiabetic agents) to indicate poisoning. Report the symptoms (780.4 and 368.8) as secondary. Also, include an E code to show the external cause of the poisoning. If the patient took the wrong dosage, for example, use E858.0 (Accidental poisoning by other drugs; hormones and synthetic substitutes).