ED Coding and Reimbursement Alert

Question: A patient with uncontrolled type II diabetes who is on insulin reports to the ED with dizziness and a headache. The patient reports that she forgot to take her insulin for a few days and attempted to -make up- the lost doses with extra injections. The ED physician determines the patient had an accidental overdose. How many diagnosis codes should I report for this encounter?


Missouri Subscriber


Answer: You-ll need five ICD-9 codes to capture all of the patient's ailments for this encounter.

Code order: When reporting all of these codes, be sure to place them in the proper order on the claim. If a patient has taken the wrong drug or takes the correct drug in the incorrect dosage, you should first report the poisoning code for the drug taken. Then, report codes for signs and symptoms that indicate the manifestation of the poisoning.

Third, you should choose the appropriate E code to indicate the external cause of the poisoning. Finally, include an ICD-9 code to represent the patient's underlying condition.

On the claim, report the following diagnosis codes:

- 962.3 (Poisoning by hormones and synthetic substitutes; insulins and antidiabetic agents) for the overdose
- 780.4 (Dizziness and giddiness) for the dizziness
- 784.0 (Headache) for the headache
- E858.8 (Accidental poisoning by other drugs; other specified drugs) to represent the cause of the overdose
- 250.02 (Diabetes mellitus without mention of complication; type II or unspecified type, uncontrolled) to represent the patient's diabetes.