Cracking the Code
Insulin Pump Malfunction Sequencing Guidance
The coding guidelines provide specific guidance on how to accurately report complications of diabetes mellitus due to insulin pump malfunction. For an underdose of insulin due to insulin pump failure, a diagnosis from subcategory T85.6, mechanical complication of other specified internal and external prosthetic devices, implants, and grafts should be sequenced as the principal diagnosis followed by code T38.3X6-, underdosing of insulin and oral hypoglycemic [antidiabetic] drugs as a secondary diagnosis. It is appropriate to assign additional diagnoses for the type of diabetes and any associated complications due to the underdosing as well. For an overdose of insulin due to insulin pump failure, a diagnosis from T85.6 should be reported as the principal diagnosis as well followed by code T38.3X1-, poisoning by insulin and oral hypoglycemic [antidiabetic] drugs, accidental (unintentional).
Q: A type 1 diabetic patient is seen in the emergency department for an initial encounter to evaluate the leakage of their insulin pump. The patient is experiencing underdosing of insulin due to the leakage.
A: T85.633A, leakage of insulin pump, initial encounter; T38.3X6A, underdosing of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter; and E10.9, type 1 diabetes mellitus without complications
Reference: ICD-10-CM Official Guidelines for Coding and Reporting FY 2021 Section I.C.4.a.5 and AHA Coding Clinic Fourth Quarter 2016 pages 71-72: Complications of other internal prosthetic devices, implants, and grafts