Hypoglycemia ICD-10-CM codes

The first question is whether the patient has diabetes. In a patient with diabetes, hypoglycemia is coded with the diabetes combination code, not E16: E11.649 for Type 2 diabetes with hypoglycemia without coma, E11.641 with coma, E10.649 and E10.641 for Type 1, E13.649 for other specified diabetes, and E09.649 for drug-induced diabetes. When the hypoglycemia results from insulin or an oral agent, add T38.3X5A (adverse effect of insulin and oral hypoglycemic drugs) plus Z79.4 (insulin), Z79.84 (oral hypoglycemic drugs), or Z79.85 (injectable non-insulin antidiabetic drugs) as applicable.

In a patient without diabetes, use E16: E16.0 drug-induced hypoglycemia without coma (with the adverse effect code for the drug), E16.1 other hypoglycemia, which includes reactive and functional hypoglycemia, and E16.2 hypoglycemia unspecified. Nondiabetic hypoglycemic coma is E15. Hyperinsulinism is E16.1, and an insulinoma is coded to the neoplasm (D13.7) with E16.1 for the resulting hypoglycemia when documented.

The E16.A- codes report the hypoglycemia level and are always additional codes, sequenced after the E16 or diabetes code: E16.A1 level 1 (glucose below 70 mg/dL), E16.A2 level 2 (glucose below 54 mg/dL), and E16.A3 level 3 (a severe event with altered mental or physical status requiring assistance, regardless of the glucose value). Assign a level code only when the provider documents the level; do not derive it from the glucose value in the lab record.