Coding Tip: Reporting Diabetic Ketoacidosis (DKA)
This Coding Tip was updated on 12/4/2018
Kim Carrier RHIT, CDIP, CCS, CCS-P
Director of Coding Quality Assurance
AHIMA Approved ICD-10-CM/PCS Trainer
How do coders report diabetic ketoacidosis in ICD-10-CM?
For FY2018 there is a new code to report Type 2 diabetic ketoacidosis (DKA). This was previously reported with code E13.1-, other specified diabetes mellitus with ketoacidosis with or without coma. Now, there is a code specifically for reporting this diagnosis. E11.1- is used to report Type 2 diabetes with DKA with or without coma.
What is diabetic ketoacidosis (DKA)?
DKA is life threatening complication in patients with diabetes. This typically occurs in patients with type 1 diabetes but can also be found in patients with type 2. When a patient has DKA it is implied that they also have hyperglycemia so no additional code is needed to report that the diabetes is with hyperglycemia. A separate standalone code for hyperglycemia is also not reported and there is an excludes1 note in the tabular.
DKA occurs when the body produces high levels of blood acids known as ketones. This develops when the body isn’t producing enough insulin. When the body does not produce or have enough insulin, the body begins to break down fat as fuel. When the body switches to burning fat this produces a buildup of acids that are called ketones. Excess ketones build up and are spilled over into the urine.
Symptoms of DKA:
- Nausea & Vomiting
- Abdominal pain
- Breathing difficulties/shortness of breath
- Increased urination
- Weakness
- Confusion
- Loss of consciousness
- Breath that smells of fruit
- Excessive thirst
- High blood sugar level and ketone levels in your urine
Causes of DKA:
- UTI
- Pneumonia
- Other infection
- Gastroenteritis
- Noncompliance with insulin or inadequate insulin administration
- Pregnancy
- MI
- Stroke
- Drug and alcohol use
- Eating disorders
- Physical trauma
- Emotional trauma
- Certain medication uses especially steroids and diuretics
Treatment for DKA:
Insulin is given to reverse the process that caused the patient to go into DKA. In severe cases, this will be given intravenously. Once the blood sugar levels fall to be below 240 mg/dL and the blood is no longer acidic, regular insulin therapy can be resumed. Fluid and electrolytes will also be replaced. The fluids are given either via mouth or IV and are given to replace the fluid lost through excessive urination. The fluid replacement will also help to dilute the excess sugar in the blood. The electrolytes will be given intravenously and are sodium, potassium and chloride. This replacement will help keep the heart, muscles and nerve cells functioning properly.
Prevention of DKA:
- Strict adherence to insulin or oral medication regimen
- Monitor blood sugars and when uncontrolled treat with insulin as instructed
- Healthy eating and physical activity
- When ill or under stress, test your urine for excess ketones (test can be purchased over the counter)
- Seek emergency medical care if DKA is suspected before it gets out of control
References:
ICD-10-CM Index
AHA Coding Clinic, Fourth Quarter 2017 Page: 6
mayoclinic.org
wikipedia.org
Happy Coding!
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
Popular Posts
Part 5: Reasons for AKI Denials and Prevention | AKI Series
Why are so many AKI records being denied? It’s hard to give one answer for why so many AKI records are being denied lately, but most appear to be due to the multiple sets of criteria available for use in determining if a patient has AKI, as well as physician documentation. As stated in Part 3 of this series, there are three main criteria/classifications used to diagnose AKI.
Part 4: Is Documentation Present to Report Acute Kidney Injury/Failure? | AKI Series
In previous parts of this series we looked at the definitions of AKI/ARF, causes, coding and sequencing, and the common clinical indicators that patients present with that are diagnosed with this condition. In Part 4, we will look at the documentation that should be present to report the diagnosis without fear of denial, as well as when a query is needed to clarify the diagnosis.
Coding Tip: Z Code Reporting for COVID-19
If the facility does a COVID-19 test, and test is negative, do I need a diagnosis code. The answer is yes, you will report a Z-code. The Z-code depends on the record documentation and circumstances of testing. For any patient receiving a COVID-19 test, if negative, there MUST e a Z-code to describe why the test was taken. (Test negative for COVID-19 and MD does not override negative results).
Part 3: Clinical Indicators for Acute Kidney Injury/Failure | AKI Series
In the first parts of this series we looked at definitions of AKI/ARF, causes, coding and sequencing. In Part 3, we will look at what clinical indicators would possibly be present to support the diagnosis of AKI/ARF.
FY2021 Proposed Rule and Code Changes Highlights
The FY2021 IPPS Proposed Rule is out and here are some highlights from it regarding ICD-10 Code proposals. We will know if these changes are permanent after the public comment period is over on July 10, 2020 and CMS prepares the Final Rule, usually out by August 1.
Subscribe to our weekly newsletter
Latest News
Part 5: Reasons for AKI Denials and Prevention | AKI Series
Why are so many AKI records being denied? It’s hard to give one answer for why so many AKI records are being denied lately, but most appear to be due to the multiple sets of criteria available for use in determining if a patient has AKI, as well as physician documentation. As stated in Part 3 of this series, there are three main criteria/classifications used to diagnose AKI.
Part 4: Is Documentation Present to Report Acute Kidney Injury/Failure? | AKI Series
In previous parts of this series we looked at the definitions of AKI/ARF, causes, coding and sequencing, and the common clinical indicators that patients present with that are diagnosed with this condition. In Part 4, we will look at the documentation that should be present to report the diagnosis without fear of denial, as well as when a query is needed to clarify the diagnosis.
Coding Tip: Z Code Reporting for COVID-19
If the facility does a COVID-19 test, and test is negative, do I need a diagnosis code. The answer is yes, you will report a Z-code. The Z-code depends on the record documentation and circumstances of testing. For any patient receiving a COVID-19 test, if negative, there MUST e a Z-code to describe why the test was taken. (Test negative for COVID-19 and MD does not override negative results).
Part 3: Clinical Indicators for Acute Kidney Injury/Failure | AKI Series
In the first parts of this series we looked at definitions of AKI/ARF, causes, coding and sequencing. In Part 3, we will look at what clinical indicators would possibly be present to support the diagnosis of AKI/ARF.
FY2021 Proposed Rule and Code Changes Highlights
The FY2021 IPPS Proposed Rule is out and here are some highlights from it regarding ICD-10 Code proposals. We will know if these changes are permanent after the public comment period is over on July 10, 2020 and CMS prepares the Final Rule, usually out by August 1.
Part 2: Specificity Coding of Acute Kidney Injury (AKI) and Sequencing | AKI Series
As discussed in Part 1 of this series, AKI/ARF is a common diagnosis that coders see daily. In Part 2, we are going to focus on the different types/specificity of AKI/ARF. We’ll learn what they mean, as well as how to code the diagnosis.
Part 1: What is Acute Kidney Injury (AKI)? | AKI Series
This is part 1 in a series focused on coding of acute kidney injury (AKI) and/or acute renal failure (ARF). AKI/ARF is reported often, but is also one of the most common diagnosis found in denials.
Coding Tip: Covid-19 Diagnosis Coding Common Scenarios
With the proliferation of COVID-19 cases, we thought we would put together a quick reference listing of some of the common scenarios that coders have asked about. As with all coding, coders should follow Official Guidelines for Coding and Reporting and the COVD-19 Frequently Asked Questions document by the AHA.
Reporting Telehealth Services During the COVID-19 Emergency
Effective March 1, Medicare will pay physicians for telehealth services at the same rate as in-person visits for all diagnoses, not just services related to COVID-19. This great for providers whose patients are reluctant to visit the office.
Coding Tip: What is Single Path Coding?
The biggest reasons why some hospital systems are moving to single path coding is to eliminate duplicative processes and to optimize productivity. In addition, costs are reduced when only one coder “touches” the record and completes both types of coding.
Coding Tip: Reporting Vaping in ICD-10-CM | Effective on 4/1/2020
Effective with 4/1/2020 discharges, ICD-10-CM code U07.0 is used to report vaping -related disorders. ICD-10-CM code U07.0 (vaping related disorder) should be used when documentation supports that the patient has a lung-related disorder from vaping. This code is found in the new ICD-10-CM Chapter 22. U07.0 will be in listed in the ICD-10-CM manual under a new section: Provisional assignment of new disease of uncertain etiology or emergency use.
Telehealth and the Coronavirus
The US government and public-health officials are urging consumers to utilize telemedicine for remote treatment, fill prescriptions and get medical attention during the new coronavirus pandemic. The goal is to keep people with symptoms at home and to practice social distancing if their condition doesn’t warrant more intensive hospital care.
Coronavirus: Tips for Working from Home
Coronavirus: Tips for working from home. Companies around the world have told their employees to stay home and work remotely. Whether you’re a new to this concept or a work from home veteran, here’s some tips to staying productive from our #HIAfamily.
Part 3: Coder and CDI Communication Example | CDI Series
This is the final part of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we provide an actual example of an effective communication response to CDI.
Part 2: How Coders Can Address Coding Mismatches | CDI Series
This is part two of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we discuss mismatches and how to best go about resolving them. In part three we will provide a case example of best practice interaction.
Part 1: How Coders Can Better Interact with CDI Teams | CDI Series
This is part one of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. Many times these departments are separate and the remote environment makes it difficult to interact efficiently between the two departments. In part one, we will discuss the history and objectives of CDI so the coder has a better understanding of CDI’s role.
Coding Tip: Coding Diagnoses on Outpatient Encounters
One reason that coders should report chronic conditions (including history and status codes) on outpatient records is the HCC’s—Hierarchical Condition Categories. The quick and easy explanation of what HCC’s are is each HCC is mapped to certain ICD-10-CM codes or code ranges. HCC coding is designed to estimate future health care costs for patients.
Part 5: Top 5 ICD-10-CM Chapters 2019 | Acute Care Reviews
For Part 5 of this 5-part series, we will look at Chapter 4 within ICD-10-CM—E00-E89—Endocrine, Nutritional, and Metabolic Diseases. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
Part 4: Top 5 ICD-10-CM Chapters 2019 | Acute Care Reviews
For Part 4 of this 5-part series, we will look at Chapter 10 within ICD-10-CM—J00-J99—Diseases of the Respiratory System. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
Part 3: Top 5 ICD-10-CM Chapters 2019 | Acute Care Reviews
For Part 3 of this 5 part series, we will look at Chapter 9 within ICD-10-CM—I00-I99—Diseases of the Circulatory System. This chapter contains so many of the everyday diagnoses that we code such as hypertension, heart disease and stroke.
Part 2: Top 5 ICD-10-CM Chapters 2019 | Acute Care Reviews
For Part 2 of this 5-part series, we will look at Chapter 1 within ICD-10-CM—A00-B99—Certain Infectious and Parasitic Diseases. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
Part 1: Top 5 ICD-10-CM Chapters 2019 | Acute Care Reviews
For Part 1 of this 5-part series, we will look at Chapter 21 within ICD-10-CM—Z00-Z99—Factors influencing health status and contact with health services. There is no possible way to include every guideline or coding reference for this chapter, but I’ll do my best to touch on some off the most common issues.
Coding & Quality Measures Tip: Social Determinants of Health
The HIM world has been buzzing recently with discussion of “Social Determinants of Health” and coded data. What does this mean for coders and the HIM field?
CDC Develops ICD-10 Code for 2019 Novel Coronavirus (COVID-19)
The Centers for Disease Control and Prevention (CDC) is in process of developing a new code for the COVID-19 (coronavirus) that will be released October 1, 2020. In the meantime, the CDC has provided advice on coding the COVID-19 coronavirus.
Most Common DRG’s with Recommendations 2019: #1
We’re finally at the #1 most common DRG with recommendations by HIA for 2019. Just to recap, HIA reviewed over 50,000 inpatient records in 2019. Most have probably already guessed what the correct DRG would be with the most recommendations. There are just some diagnoses and DRG’s that will always be a thorn in the side for coders. #1 DRG with the most recommendations during HIA reviews : DRG 871—Septicemia or severe sepsis w/o mechanical ventilation >96 hours with MCC
Most Common DRG’s with Recommendations 2019: #2
We’re now at the second most common DRG with recommendations by HIA for 2019. Just to recap, HIA reviewed over 50,000 inpatient records in 2019. We are counting down to # 1. #2 DRG with the most recommendations during HIA reviews: DRG 872—Septicemia or severe sepsis w/o mechanical ventilation >96 hours w/o MCC.
Most Common DRG’s with Recommendations 2019: #3
In 2019, HIA reviewed over 50,000 inpatient records. Wow! That is a lot of records. Even with this large number of records, the DRG’s with recommendations are still the ones that coders typically see during audits. #3 DRG 190—Chronic obstructive pulmonary disease with MCC.
Most Common DRG’s with Recommendations 2019: #4
In 2019, HIA reviewed over 50,000 inpatient records. Wow! That is a lot of records. Even with this large number of records, the DRG’s with recommendations are still the ones that coders typically see during audits. #4 is DRG 193—Simple pneumonia & pleurisy with MCC.
Most Common DRG’s with Recommendations 2019: #5
In 2019, HIA reviewed over 50,000 inpatient records. Wow! That is a lot of records. Even with this large number of records, the DRG’s with recommendations are still the ones that coders typically see during audits. #5 DRG with the most recommendations during HIA reviews : DRG 853—Infectious & Parasitic diseases with O.R. procedure with MCC