Monday, September 27, 2021

Injectable Non-insulin Drugs

In the kNOW” this month is going to explore the topic of ICD-10-CM coding for injectable non-insulin drugs for treatment of diabetes.  Let’s begin by identifying exactly what those medications are and why they are used.

Diabetes is a disease manifested by high glucose (blood sugar) levels.  Insulin is the hormone that facilitates glucose absorption into the body’s cells.  For Type 1 diabetics, their body does not produce insulin, whereas with Type 2 diabetics, cells become resistant to insulin and production of insulin may be at an insufficient level to overcome the resistance.    

Injectable non-insulin medications are glucagon-like peptide-1 (GLP-1) agonists which are a hormone that treats diabetes in four ways.  First, it reduces appetite.  Second, it slows down gastric emptying.  Third, it increases the release of insulin from the pancreas.  Fourth, it decreases glucose production by the liver.  These medications do not have a specific long-term use code and are therefore coded in ICD-10-CM with code Z79.899 for Other long-term (current) drug therapy.   Examples of these include: Byetta, Victoza, Ozempic, and Trulicity. 

Type 1 diabetics require insulin which is supplied via injection.  When coding in ICD-10-CM for long-term use of insulin, coding professionals assign Z79.4.  The treatment for Type 2 diabetics can vary.  Sometimes, diet control and lifestyle changes can manage blood glucose levels.  Other times, an oral hypoglycemic medication, like Metformin, is required.  The coding for long-term use of oral hypoglycemics is Z79.84. 

Official Coding Guidelines were updated for 2021 with regards to coding when a combination of diabetic medications is used.  Previous guidance, which is still in effect, indicated that when insulin and oral hypoglycemics were both used, coding professionals should only assign the Z79.4 code for the long-term insulin usage.*  If injectable non-insulin medications are supplied in conjunction with insulin, both Z79.4 and Z79.899 are to be assigned.  Likewise, if both oral hypoglycemics and injectable non-insulin drugs are used assign Z79.84 and Z79.899.

As a reminder, it is inappropriate to assign Z79.4 for the long-term use of insulin when insulin is administered temporarily to control a Type 2 diabetic’s glucose level during an episode of care. 

Now you are In the kNOW!!

* This guidance is changing with the October 1, 2021 ICD-10-CM code updates for CY 2022.  An update to guideline I.C.4.a.3 will direct coders to assign codes for both insulin and oral hypoglycemics when a patient is treated with both medications.



About the Author 

Dianna Foley, RHIA, CHPS, CCS, CDIP  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.