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E16.1
ICD-10-CM
Hyperinsulinemia

Understanding hyperinsulinemia diagnosis, treatment, and management is crucial for healthcare professionals. This resource provides information on clinical documentation, medical coding (ICD-10 codes), insulin resistance, laboratory testing, and differential diagnosis related to hyperinsulinemia. Learn about symptoms, causes, and the connection to metabolic syndrome, hypoglycemia, and diabetes. Explore effective strategies for accurate diagnosis and optimal patient care for hyperinsulinemia.

Also known as

Hyperinsulinism
Functional Hyperinsulinism

Diagnosis Snapshot

Key Facts
  • Definition : High levels of insulin in the blood, often with normal or low blood sugar.
  • Clinical Signs : Often no symptoms. Sometimes hunger, weight gain, low blood sugar, fatigue.
  • Common Settings : Primary care, endocrinology, diabetes clinics.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC E16.1 Coding
E16.1

Drug-induced hyperinsulinism

Excessive insulin caused by medication.

E16.2

Other hyperinsulinism

Excessive insulin not due to drugs or tumors.

D35.0

Benign insulinoma

Non-cancerous tumor causing excess insulin.

D13.7

Benign neoplasm of pancreas

Non-cancerous pancreatic tumor, may include insulinoma.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is hyperinsulinemia due to medication?

  • Yes

    Specify medication

  • No

    Is it due to a genetic defect?

Documentation Best Practices

Documentation Checklist
  • Document elevated insulin levels with specific units.
  • Confirm hyperinsulinemia diagnosis with supporting lab results.
  • Exclude other causes of hypoglycemia, clearly documented.
  • Note symptoms related to hyperinsulinemia, if present.
  • Record patient's medical history, including medications.

Coding and Audit Risks

Common Risks
  • Unspecified Hyperinsulinemia

    Coding E16.1 without further specificity when clinical documentation supports a more precise diagnosis like familial or drug-induced hyperinsulinemia.

  • Neonatal vs. Adult Onset

    Incorrectly coding P70.2 (neonatal) when documentation indicates onset after the neonatal period, requiring E16.1. Impacts quality metrics and severity.

  • Confusing Cause vs. Effect

    Miscoding hyperinsulinemia as a consequence of another condition when it is the primary cause. Requires careful review of clinical documentation.

Mitigation Tips

Best Practices
  • Accurate ICD-10 coding: E16.0, E16.1, E16.8, E16.9 for Hyperinsulinemia
  • Document insulin levels, C-peptide, glucose, symptoms for CDI
  • Review medication list for insulin secretagogues, sulfonylureas. Adhere to Rx guidelines
  • Detailed patient history, family history of diabetes, hypoglycemia crucial for compliant documentation
  • Lifestyle interventions: Weight management, exercise, low-glycemic diet for improved outcomes

Clinical Decision Support

Checklist
  • 1. Fasting insulin level ICD-10: E16.1 documented?
  • 2. Whipple's triad present and documented?
  • 3. Evaluate for insulin resistance, document findings.
  • 4. Rule out other causes of hypoglycemia, document.

Reimbursement and Quality Metrics

Impact Summary
  • Hyperinsulinemia reimbursement hinges on accurate ICD-10 coding (E16.1, E16.8, or secondary diagnoses) impacting hospital revenue cycle management.
  • Correct coding for hyperinsulinemia affects quality metrics related to diabetes management and hypoglycemia events, influencing hospital rankings.
  • Precise documentation of hyperinsulinemia supports medical necessity reviews, optimizing reimbursement and minimizing claim denials for insulin therapy.
  • Hyperinsulinemia diagnosis coding accuracy influences publicly reported hospital quality data on metabolic disorders, impacting patient choices.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes for . Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code E16.1 for Hyperinsulinemia
  • Document insulin, C-peptide levels
  • Query physician if cause unclear
  • Check for neonatal hypoglycemia
  • Exclude insulin resistance diagnoses

Documentation Templates

Patient presents with symptoms suggestive of hyperinsulinemia, including hypoglycemia, reactive hypoglycemia,  insulin resistance, and possible insulinoma.  The patient reports experiencing symptoms such as shakiness, sweating, anxiety, palpitations, confusion, and hunger, particularly after meals or during periods of fasting.  Fasting blood glucose and insulin levels were measured, and a 72-hour fast may be indicated if initial results are inconclusive.  Differential diagnosis includes other causes of hypoglycemia, such as non-islet cell tumor hypoglycemia (NICTH) and functional hypoglycemia.  Assessment of C-peptide levels is necessary to differentiate between endogenous and exogenous hyperinsulinemia.  Medical history includes current medications, dietary habits, and any relevant family history of endocrine disorders.  Initial management may involve dietary modifications, focusing on frequent small meals with complex carbohydrates and avoiding refined sugars.  If dietary modifications are insufficient, medical treatment options may be considered, including medications to suppress insulin secretion or improve insulin sensitivity.  The patient was educated on the importance of blood glucose monitoring and recognizing symptoms of hypoglycemia.  Follow-up appointments are scheduled to monitor treatment efficacy and adjust management as needed.  Further investigation may involve imaging studies, such as abdominal CT or MRI, to evaluate for the presence of an insulinoma.  This documentation supports ICD-10 code E16.1 for drug-induced hyperinsulinemia, or E16.2 for other hyperinsulinemia, depending on etiology, and relevant CPT codes for laboratory tests and procedures performed.  Continued monitoring and management are crucial to mitigate the risks associated with chronic hyperinsulinemia, such as weight gain, metabolic syndrome, and cardiovascular disease.