Primary Care Coding Alert

Question: One of our doctors provided the following diagnosis for a diabetic patient: “patient has type 1 diabetes in good control but with frequent hypoglycemia.” This seems contradictory – if the diabetes is under good control, why is the patient experiencing frequent hypoglycemia? Even so, how do I code this? Do I use E10.9 or E10.64?

Texas Subscriber

Answer: Without knowing the patient’s blood sugar levels, it is hard to know which ICD-10 code you should assign to describe the patient’s condition. ICD-10 does not suggest parameters for hypoglycemia, but the American Diabetes Association (ADA) defines the condition as a blood sugar level below 70 mg/dl (Source:  www.diabetes.org/diabetes/medication-management/blood-glucose-testing-and-control/hypoglycemia). If the patient’s labs indicated that at the time of the encounter, and assuming the patient was not in a coma, you would report E10.649 (Type 1 diabetes mellitus with hypoglycemia without coma).

On the other hand, E10.9 (Type 1 diabetes mellitus without complications) might be appropriate as your provider is seemingly indicating that the patient’s diabetes was under control at the time of the encounter. But most patients do not have optimal control over their diabetes, and complications go hand in hand with the condition. So, coding E10.9 is rare for most diabetic patients and looks unlikely in this scenario.

In the end, the final decision for this diagnosis must rest with the provider, and you should certainly go back to the physician to understand exactly what he or she had in mind when providing it.