E16.1
E16.1: Other hypoglycemia
Billable / specific codeICD-10-CM
E16.1 is a billable, specific ICD-10-CM code for other hypoglycemia. It is valid for submission on a claim.
Check E16.1 with the rest of the claim: free scrubberExcludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
Use additional code
Add a secondary code to capture the detail described below.
- code for hypoglycemia level, if applicable (E16.A-)
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Functional hyperinsulinism
- Functional nonhyperinsulinemic hypoglycemia
- Hyperinsulinism NOS
- Hyperplasia of pancreatic islet beta cells NOS
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
E16.1 is named in 3 Medicare coverage policies: 3 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A56421Billing and Coding: CT of the Abdomen and Pelvis
- A56686Billing and Coding: HbA1c
- A57361Billing and Coding: Monitored Anesthesia Care
Alphabetic index entries that lead here
- Hyperinsulinism(functional)
- Encephalopathy›posthypoglycemic(coma)
- Hyperinsulinism›ectopic
- Hypoglycemia›functional, nonhyperinsulinemic
- Hypoglycemia›infantile
- Hypoglycemia›reactive(not drug-induced)
- Encephalopathy›in›hyperinsulinism
- Hyperinsulinism›with›encephalopathy
- Hyperplasia, hyperplastic›pancreatic islet cells›beta
Code history
Unchanged in every release from FY2024 to FY2027.