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Question: Our provider documented a patient with prediabetes and hypoglycemia. The patient was being treated for the prediabetes with metformin. How should I code this?

New Jersey Subscriber

Answer: There are two different ways to code this scenario, and they depend on whether the patient鈥檚 hypoglycemia is related to the metformin use or not. If the hypoglycemia is due to the metformin use, you would code the hypoglycemia with E16.0 (Drug-induced hypoglycemia without coma), assuming that the patient was not comatose at the time of the encounter. The code comes with a note that tells you to 鈥淯se additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5).鈥� This means you would add T38.3X5A (Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter), assuming this was the initial encounter. You would also code the prediabetes with R73.03 (Prediabetes).

However, if the provider determines that the drug has not caused the hypoglycemia, and uses E16.2 (Hypoglycemia, unspecified) to document the condition, you will not be able to code R73.03 for the prediabetes. That鈥檚 because the parent code note for the R73.0 (Abnormal glucose) codes state that E16.2 is an Excludes1 code, meaning it is mutually exclusive to codes in the R73.0- family of codes. So, you would only use E16.2 if the hypoglycemia is not metformin-induced.