Rule out insulinoma


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Our patient has a complex medical history including one of hypoglycemia. My doctor is recommending a referral to a specialist to "rule out insulinoma." Now, according to the guidelines, I shouldn't code that the patient has an insulinoma (D37.8). Instead I should code the signs and symptoms. The problem is, I don't know which signs and symptoms are appropriate. The patient does not have a current isolated incidence of hypoglycemia. There is no mention of the doctor palpating a mass.

His examination reads in part:

"There is extensive scar tissue related to prior bariatric surgery. There is moderate epigastric tenderness. There is moderate right upper quadrant tenderness. Murphy's sign is equivocal. No definite ascites. Liver, spleen, kidneys are not enlarged. There is also tenderness involving the left lower abdomen. No abnormal masses. Femoral pulsations are decreased bilaterally, but no bruits."

Elsewhere in the report, he states: "In regards to diabetes, he is being evaluated for insulinoma."

So, do I go with something like Z86.39 (Hx of other endocrine, nutritional or metabolic disorders)? Otherwise, I'm not sure which symptoms would pertain to a possible insulinoma. Thank you in advance!