Cracking the Code

Updated Guidance for Reporting Long Term Use of Insulin and Oral Hypoglycemic Medication

In the medical coding field, coding guidelines are always changing. Sometimes, CMS will create a guideline for a fiscal year and revise that same guideline the following year. Then, revise the guideline once again to the initial guidance. Per coding guidelines FY 2021, CMS instructed coders to only report Z79.4, long term use of insulin when a patient was on long term insulin and oral hypoglycemic medication. There is new guidance for FY 2022! Going forward, coders are instructed to report BOTH Z79.4 and Z79.84, long term use of oral hypoglycemic when a provider’s documentation states that a patient is using both medications. Typically, it is not marked as an error when coders do not capture certain Z codes. However, since this information is a coding guideline, then this will count as an error for a coder’s audit review. Be sure to remember this guidance going forward starting with October 1, 2021 discharges.

Q: A 28-year-old male patient presents to the ED with complaints of dizziness and weakness. He is a type II diabetic and takes Novolog and Metformin daily. Provider orders a blood test and results return with a positive diagnosis of hypoglycemia.
A: E11.649, type 2 diabetes mellitus with hypoglycemia without coma
Z79.4, long term use of insulin
Z79.84, long term use of oral hypoglycemic
Reference: ICD-10-CM Official Guidelines for Coding and Reporting Section I.C.4.a.3.
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