AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2024 Issue 2; Ask the Editor

Hypoglycemia due to Insulinoma Status Post Distal Pancreatectomy

A patient was seen for outpatient Y90 radioembolization for metastatic liver disease. The patient has a past medical history of pancreatic neuroendocrine tumor (PNET) with metastatic disease to the liver and is status post distal pancreatectomy. Y90 radioembolization was performed uneventfully; however, the patient was noted to be severely hypoglycemic prior to the Y90 radioembolization and was subsequently admitted. During the admission, the patient required frequent blood sugar monitoring and dextrose drip to maintain sugars and was started on total parenteral nutrition for long-term blood sugar and electrolyte control. The discharge summary noted hypoglycemia due to malignant insulinoma. How is hypoglycemia due to insulinoma coded when the patient has a history of a distal pancreatectomy? What is the proper sequencing for this admission? ...

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