2025 ICD-10-CM code E16.1
Other hypoglycemia. This code excludes diabetes with hypoglycemia, hypoglycemia in infant of a diabetic mother, and neonatal hypoglycemia.
Medical necessity for services related to E16.1 is established by documenting the signs, symptoms, and laboratory findings consistent with hypoglycemia not caused by diabetes or other known conditions.The documentation should support the need for diagnostic testing or treatment to manage the hypoglycemia and prevent complications like seizures or altered mental status.
Providers diagnose the disease based on history, physical examination, and signs and symptoms. Laboratory tests include blood tests for fasting plasma glucose and HbA1c, lipid panel, and urine examination.
In simple words: This code represents a low blood sugar level not caused by diabetes or other specific conditions like medication side effects, or problems with the mother during pregnancy or birth.
Other hypoglycemia encompasses various conditions not otherwise specified, including functional hyperinsulinism, functional nonhyperinsulinemic hypoglycemia, and hyperinsulinism NOS. It also includes hyperplasia of pancreatic islet beta cells NOS.Conditions specifically excluded are diabetes with hypoglycemia (E08.649, E10.649, E11.649, E13.649), hypoglycemia in infant of a diabetic mother (P70.1), and neonatal hypoglycemia (P70.4).
Example 1: A patient presents with recurrent episodes of dizziness, sweating, and confusion. Lab tests reveal low blood sugar, but the patient does not have diabetes. Further investigation reveals an insulinoma, a tumor in the pancreas that causes excess insulin production. E16.1 is used to code the non-diabetic hypoglycemia., An infant born to a non-diabetic mother experiences low blood sugar shortly after birth. After ruling out other neonatal conditions, the hypoglycemia is determined to be transient and resolves without specific treatment. E16.1 would be appropriate to document this condition, distinguishing it from neonatal hypoglycemia associated with maternal diabetes., A patient with a history of gastric bypass surgery experiences postprandial hypoglycemia (low blood sugar after meals). This is due to rapid gastric emptying and exaggerated insulin release. Since the hypoglycemia is not directly related to the surgery itself, E16.1 is used.
Documentation should include symptoms, lab results confirming hypoglycemia (low blood glucose levels), and any relevant diagnostic tests to rule out other causes of hypoglycemia, such as insulinoma or other endocrine disorders.It's important to document the absence of diabetes and that the hypoglycemia is not drug-induced.
- Specialties:Endocrinology, Internal Medicine, Family Medicine, Pediatrics
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office, Emergency Room - Hospital