E16.1 ICD-10-CM Code: Other hypoglycemia
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Other disorders of glucose regulation and pancreatic internal secretion (E15-E16)
E16.1
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther hypoglycemia
This code describes low blood sugar levels that are not caused by diabetes or insulin use. It can result from conditions like liver disease, hormonal imbalances, or certain medications.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Functional hyperinsulinism
- Functional nonhyperinsulinemic hypoglycemia
- Hyperinsulinism NOS
- Hyperplasia of pancreatic islet beta cells NOS
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E16.1 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E16.1 in this effective period.
Excludes 1
Official- diabetes with hypoglycemia (E08.649, E10.649, E11.649, E13.649)
- hypoglycemia in infant of diabetic mother (P70.1)
- neonatal hypoglycemia (P70.4)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E16.1 in this effective period.
Use Additional
Official- code for hypoglycemia level, if applicable (E16.A-)
Code Also
OfficialICD-10-CM does not list Code Also instructions for E16.1 in this effective period.
Buddy Documentation Tip
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is E16.1 an HCC code?
No. E16.1 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- E16.1
- Description
- Other hypoglycemia
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
E16.1 is the ICD-10-CM diagnosis code for other hypoglycemia. This code describes low blood sugar levels that are not caused by diabetes or insulin use. It can result from conditions like liver disease, hormonal imbalances, or certain medications. E16.1 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering other disorders of glucose regulation and pancreatic internal secretion (e15-e16).
E16.1 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Verify the cause of hypoglycemia is documented and not related to diabetes (which would use E10-E14 codes) or insulin administration.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for E16.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify the cause of hypoglycemia is documented and not related to diabetes (which would use E10-E14 codes) or insulin administration
- •Review the clinical documentation to ensure the hypoglycemia is not drug-induced or secondary to another documented condition, as this may require additional coding
Excludes 1, Do NOT code together
Use Additional Code
- code for hypoglycemia level, if applicable (E16.A-)