ICD-10 Coding for Hyperinsulinemia(E16.1)
Complete ICD-10-CM coding and documentation guide for Hyperinsulinemia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hyperinsulinemia
E15-E16Primary Range
Other disorders of glucose regulation and pancreatic internal secretion
This range includes codes for conditions related to abnormal insulin levels, including hyperinsulinemia.
Key Information: ICD-10 code for hyperinsulinemia
Essential facts and insights about Hyperinsulinemia
Primary ICD-10-CM Code for hyperinsulinemia
Decision Criteria
clinical Criteria
- Insulin levels above 12 pmol/L during hypoglycemia
coding Criteria
- Exclude diabetic hypoglycemia
Applicable To
- Functional hyperinsulinism
- Hyperplasia of pancreatic islet beta cells
Excludes
- Hypoglycemia in diabetes (E11.649)
Clinical Validation Requirements
- Insulin levels above 12 pmol/L (2 mU/L) during hypoglycemia
- Suppressed ketones and free fatty acids
Code-Specific Risks
- Incorrectly coding diabetic hypoglycemia as E16.1
Coding Notes
- Ensure documentation specifies the type and cause of hyperinsulinemia.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Long-term insulin use
Z79.4Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hyperinsulinemia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E16.1.
Impact
Clinical: Inaccurate diagnosis leading to improper treatment., Regulatory: Potential audit failures., Financial: Denied claims due to insufficient documentation.
Mitigation Strategy
Always include lab results in patient records., Use templates to ensure completeness.
Impact
Reimbursement: Incorrect DRG assignment leading to reimbursement issues., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Use E11.649 for hypoglycemia in diabetes.
Impact
Using E16.1 instead of E11.649 for diabetic patients.
Mitigation Strategy
Educate staff on differentiation between diabetic and non-diabetic hypoglycemia.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Hyperinsulinemia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hyperinsulinemia
Use these documentation templates to ensure complete and accurate documentation for Hyperinsulinemia. These templates include all required elements for proper coding and billing.
Congenital Hyperinsulinism
Specialty: EndocrinologyRequired Elements
- Genetic testing results
- Insulin and glucose levels
- Response to treatment
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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