Coding For Diabetes - AHIMA
Coding for DiabetesAudio Seminar/WebinarApril 10, 2008Practical Tools for Seminar Learning Copyright 2008 American Health Information Management Association. All rights reserved.
DisclaimerThe American Health Information Management Association makes norepresentation or guarantee with respect to the contents herein and specificallydisclaims any implied guarantee of suitability for any specific purpose. AHIMA hasno liability or responsibility to any person or entity with respect to any loss ordamage caused by the use of this audio seminar, including but not limited to anyloss of revenue, interruption of service, loss of business, or indirect damagesresulting from the use of this program. AHIMA makes no guarantee that the useof this program will prevent differences of opinion or disputes with Medicare orother third party payers as to the amount that will be paid to providers of service.As a provider of continuing education, the American Health InformationManagement Association (AHIMA) must assure balance, independence, objectivityand scientific rigor in all of its endeavors. AHIMA is solely responsible for control ofprogram objectives and content and the selection of presenters. All speakers andplanning committee members are expected to disclose to the audience: (1) anysignificant financial interest or other relationships with the manufacturer(s) orprovider(s) of any commercial product(s) or services(s) discussed in an educationalpresentation; (2) any significant financial interest or other relationship with anycompanies providing commercial support for the activity; and (3) if thepresentation will include discussion of investigational or unlabeled uses of aproduct. The intent of this requirement is not to prevent a speaker withcommercial affiliations from presenting, but rather to provide the participants withinformation from which they may make their own judgments.The faculty has reported no vested interests or disclosures regarding thispresentation.AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reservedi
FacultyDeresa Claybrook, MS, RHIT, is president of Positive ResourceConsulting, focusing primarily on HIM and human resource issuesacross all settings. Ms. Claybrook has over 25 years in the HIM fieldincluding experience as a coder, HIM director, instructor, and longterm care administrator. She is currently involved at the state level onthe Oklahoma Health Information Exchange project, and is a frequentspeaker and writer on various HIM topics.Susan Mitchell, MS, RN, CDE, CNS, is a clinical nurse specialistand certified diabetes educator at the ediba Diabetes Center forExcellence (DCE) in Oklahoma City, OK. Ms. Mitchell serves as aconsultant to DEC-affiliated hospitals throughout Oklahoma, assistingthem in establishing inpatient glycemia management programs andoutpatient diabetes education programs. She is also the programcoordinator of the Diabetes Education Program at DCE, which asachieved recognition from the American Diabetes Association formeeting national standards for quality diabetes education.AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reservedii
Table of ContentsDisclaimer . iFaculty .iiSeminar Objectives . 1Polling Question #1. 1DiabetesInformation . 2Diagnosing Diabetes . 4Polling Question #2 . 5Types of DiabetesType 1. 6Type 2. 7Coding DiabetesGuidelines. 8Gestational Diabetes. 9Pre-diabetes .11Diabetes Mellitus in Pregnancy and Gestational Diabetes .11Coding Example .12Metabolic Syndrome .12Complications of Diabetes .15Macrovascular Disease .16Peripheral Neuropathy .16Autonomic Neuropathy .17Coding Complication .18Nephropathy.18Coding Nephropathy .19Retinopathy .21Coding Ophthalmic Manifestation.23Pharmacological Therapy .24Insulin Pumps .26Coding Mechanical Devices.27Inpatient Concerns.28Polling Question #3 .29Documentation and Coding .31Acute Complications .33Coding Diabetic Ketoacidosis .35HHS Characteristics and Clinical Findings .36Coding Hypoglycemia .37Resources .38Audience QuestionsAppendixCE Certificate Instructions .43AHIMA 2008 Audio Seminar Series
Coding for DiabetesNotes/Comments/QuestionsObjectives Overview of diabetes Discuss clinical knowledge ofdiabetes and it’s complicationsaffecting other body systems. Review ICD-9-CM diagnostic codingguidelines and case scenarios1Polling Question #1What type of facility do you represent?*1 Hospital*2 Large Clinic*3 Physician office*4 Other setting2AHIMA 2008 Audio Seminar Series1
Coding for DiabetesNotes/Comments/QuestionsDiabetes - an increasing concern20.8 million with Diabetes in U.S. (7% of population) 14.6 million diagnosed 6.2 million undiagnosed 41 million with prediabetesADA 2005 statistics3Every Day: 41,000 new diagnosis of diabetes 810 die from its complications 230 amputations 120 go on dialysis 55 go blind4AHIMA 2008 Audio Seminar Series2
Coding for DiabetesNotes/Comments/QuestionsWhat is Diabetes?Metabolic DisorderHyperglycemiaAbsolute Deficiency of InsulinorRelative Decrease in Secretion &Effectiveness of Insulin5Interplay of HormonesInsulin-produced continuously by beta cells in pancreas.Promotes entry of glucose into cells.Amylin-produced by beta cells in pancreas, co- secretedwith insulin. Enhances insulin action, slows gastricemptying, inhibits glucagon.Incretin hormones- secreted from gut, GLP-1 and DPP-4inhibitors. Promote action of insulin, slows gastricemptying, inhibits glucagon.Glucagon- produced by alpha cells of pancreas. One of thecounter regulatory hormones which works theopposite of insulin. Decreases insulin action,increases glucose production by liver.Other counter regulatory hormones: cortisol,growth hormone, epinephrine6AHIMA 2008 Audio Seminar Series3
Coding for DiabetesNotes/Comments/QuestionsDiagnosing Diabetes FBG 126 X 2 Random BG 200plus classic symptoms Polyuria Polydipsia Unexplained weight lossNormal Blood Glucose (BG) 100 mg/ dL OGTT 2 hour 2 hour sample 200 All Plasma Glucose7Signs and Symptoms of Diabetes Polyuria Polydypsia Polyphagia Weight loss Nausea, vomiting Blurred vision Fatigue Frequent infections Slow healing Tingling hands and feet8AHIMA 2008 Audio Seminar Series4
Coding for DiabetesNotes/Comments/QuestionsPolling Question #2How do the majority of your physicianscurrently document diabetes mellitus?*1 IDDM or NIDDM*2 Type 1 and Type 2 Diabetes*3 Adult Onset NIDDM or Juvenile IDDM*4 Type I and Type II Diabetes*5 All of the above9Types of Diabetes Type 1 type I, IDDM Type 2 type II, NIDDM Gestational Diabetes Other10AHIMA 2008 Audio Seminar Series5
Coding for DiabetesNotes/Comments/QuestionsType 1Type 1 “Profile”Genetic predispositionEnvironmental factorsAutoimmune process10% of diabetesyounger 30 yr. oldINSULIN DEFICIENCYDestruction of Beta Cellsprone to ketoacidosissudden onset ofsymptoms and illnessInsulin TONESAHIMA 2008 Audio Seminar Series126
Coding for DiabetesNotes/Comments/QuestionsTreatment for Type 1 Insulin Pramlintide (Symlin ) Exercise & Nutrition Complication Prevention13Type 2Genetic PredispositionAcquired FactorsInsulin Resistance(decreased cell sensitivity)Decreased Insulin SecretionIncreased liver glucoseproductionType 2 “Profile” 90% of diabetes usually older than30 years old INSULINRESISTANCE not prone toketoacidosis gradual onset ofsymptoms or none 80% overweight ;20% lean14AHIMA 2008 Audio Seminar Series7
Coding for DiabetesNotes/Comments/QuestionsTreatment for Type 2 Exercise & Nutrition Medications Complication prevention15Coding Diabetes GuidelinesThe below listed diabetes guidelines are not inclusive. The coder shouldrefer to the applicable Coding Clinic guidelines for additional informationand also ICD-9-CM Official Guidelines for Coding and Reporting EffectiveOctober 1, 2007Fifth-digits for category 250:The following are the fifth-digits for the codes under category 250:0 type II or unspecified type, not stated as uncontrolled1 type I, [juvenile type], not stated as uncontrolled2 type II or unspecified type, uncontrolled3 type I, [juvenile type], uncontrolledThe age of a patient is not the sole determining factor, though most type Idiabetics develop the condition before reaching puberty. For this reasontype I diabetes mellitus is also referred to as juvenile diabetes.Type of diabetes mellitus not documentedIf the type of diabetes mellitus is not documented in themedical record the default is type II.16AHIMA 2008 Audio Seminar Series8
Coding for DiabetesNotes/Comments/QuestionsCoding Diabetes Guidelines If the documentation in a medical record doesnot indicate the type of diabetes but doesindicate that the patient uses insulin, theappropriate fifth-digit for type II must be used.For type II patients who routinely use insulin,code V58.67, Long-term (current) use of insulin,should also be assigned to indicate that thepatient uses insulin. Code V58.67 should not beassigned if insulin is given temporarily to bring atype II patient’s blood sugar under control duringan encounter.17Gestational Diabetes Glucose intolerance duringpregnancy Women at risk are screenedat 24-28 weeks gestation Management – diet/exercise –glyburide, metformin, insulin Resolves after the delivery At high risk for developingtype 2 diabetes later in life.18AHIMA 2008 Audio Seminar Series9
Coding for DiabetesNotes/Comments/QuestionsDiagnosis Gestational DiabetesFasting95 mg/dL1 hour180 mg/dL2 hour155 mg/dL3 hour140 mg/dL100 g glucose loadDiagnosis made with 2 or more elevated values19Goals for Pregnancy and DiabetesFasting plasma glucose65 – 100 mg/dLPostprandial plasma glucose1 hour:110 – 135 mg/dL2 hour: 120 mg/dL2 a.m.-6:00 a.m. 65-135 mg/dL20AHIMA 2008 Audio Seminar Series10
Coding for ed Fasting Glucose (IFG)FPG 100-125 mg/dLImpaired Glucose Tolerance (IGT)2 hr PG 140-199 mg/dL21Diabetes Mellitus in Pregnancyand Gestational DiabetesDiabetes mellitus in pregnancyDiabetes mellitus is a significant complicating factor in pregnancy.Pregnant women who are diabetic should be assigned code 648.0x,Diabetes mellitus complicating pregnancy, and a secondary code fromcategory 250, Diabetes mellitus, to identify the type of diabetes.Gestational diabetesGestational diabetes can occur during the 2nd and 3rd trimester ofpregnancy in women who were not diabetic prior to pregnancy.Gestational diabetes can cause complications in pregnancy similar tothose of pre-existing diabetes mellitus after pregnancy It also putsthe woman at risk for developing diabetes after pregnancy.Gestational diabetes is coded to 648.8x Abnormal glucose tolerance.Codes 648.0x and 648.8x should never be used together on the samerecord. Code V58.67. Long term (current) use of insulin, should alsobe assigned if the gestational diabetes is being treated with insulin.22AHIMA 2008 Audio Seminar Series11
Coding for DiabetesNotes/Comments/QuestionsCoding for DiabetesEmergency room visit:A 28 year old diabetic at 36 weeks gestation presents to the ED thisevening with concerns that the fetus has not moved at all today.The patient was instructed at her last clinic visit to count fetalmovement during a 30 minute period daily and seek promptattention if she noticed a sudden decrease in fetal movement. This isthe patients first pregnancy and control of her type I diabetes hasbeen fairly adequate throughout the pregnancy. Blood glucose levelin the ED is 120. A limited ultrasound examination demonstratesfetal movements with normal heartbeat recorded. The patient isdischarged home with instructions to rest on her left side throughthe night and report to the obstetrical clinic tomorrow morning.Code assignment:655.73 Decreased fetal movements648.03 Diabetes mellitus complicating pregnancy250.01 Diabetes mellitus, type 123Metabolic Syndromediagnosis when 3 or more risk factors are present Elevated blood pressure 130/85 Central (abdominal) adipositymen 40 in. women 35 in. Low HDL-C men 40 mg/dL women 50 mg/dL Elevated triglycerides 150 mg/dL Elevated fasting blood glucose 100 mg/dLindicative of insulin resistanceNCEP Adult Treatment Panel IIIAHIMA 2008 Audio Seminar Series2412
Coding for DiabetesNotes/Comments/QuestionsGlycemic Control GuidelinesADAACE / AACEPre-prandial BG90-130 110Post-prandial 2 hr 180 140 7 6.5A1CAmerican Diabetes Assoc. 2003, American College Clinical Endocrinology 200225Hemoglobin A1C “average” blood glucose over 3- 4 monthsmeasures amount of glucose that attaches toprotein in the red blood cells- glycosylationNormal A1C- 4-6%Higher the glucose in the blood the higher the A1Cresults For example, a BG of 310 is A1C of 11%240 is A1C of 9%170 is A1C of 7%135 is A1C 0f 6%26AHIMA 2008 Audio Seminar Series13
Coding for DiabetesNotes/Comments/QuestionsLipid GoalsCholesterol (mg/dL) 200LDL-C (mg/dL) 100HDL-C (mg/dL) 40TG (mg/dL) 150Blood Pressure Goal 130/ 8027Long Term Complications Microvascular Disease - retinopathy,nephropathy, neuropathy (peripheral,autonomic, cranial)Macrovascular Disease - cardiovascular,cerebrovascular, peripheral vascularDermatologicalMusculoskeletalDelayed growth and developmentPeriodontal diseaseUnusual infections28AHIMA 2008 Audio Seminar Series14
Coding for DiabetesNotes/Comments/QuestionsDiabetes Associated with DepressionEating disordersThyroid diseaseCystic FibrosisRheumatoidarthritisAlzheimer’s diseasePolycystic ovarysyndrome Osteoporosis Sleep apnea Breast Cancer Celiac Disease29Complications of Diabetes25x2-4x17x2-6xAHIMA 2008 Audio Seminar Series5x3015
Coding for DiabetesNotes/Comments/QuestionsMacrovascular Disease Diabetes isProthrombicProinflammatoryAtherosclerosis occurs at earlier age andadvances more rapidlyManifested as Cardiovascular disease Cerebrovascular disease Peripheral vascular disease31Peripheral NeuropathyDamage is distal and symmetricalaffecting the feet, hands, legsInsidious onset, progressiveSigns/ symptoms:painful - shooting, stabbing,gnawing, burning, extremehypersensitivity, severe aching,worse at nightnon painful- numbness, tingling,dead feet, stocking glove effectLoss of protective is #1 cause ofulcers and amputations.AHIMA 2008 Audio Seminar Series3216
Coding for DiabetesNotes/Comments/QuestionsAutonomic NeuropathyCardiovascular Autonomic NeuropathyPostural hypotension, Cardiac denervation,Fixed heart rateGastrointestinalGastroparesis (gastropathy)delayed stomach emptyingDiabetic diarrhea, constipationGenitourinaryNeurogenic bladderSexual dysfunctionImpaired insulin counterregulationHypoglycemic unawarenessSudomotor dysfunction (sweating)Pupillary response33Coding for Diabetes and ArteriosclerosisConditionICD-9-CM CodesDiabetic peripheralvascular disease causingintermittent claudication250.7x, 443.81Diabetic atherosclerosiswith gangrene250.7x, 440.24 (Code forgangrene is included in440.24)Note: New 2008 code 440.4should be used in addition tocode 440.24 if total occlusionof arteries of the extremitiesis present.34AHIMA 2008 Audio Seminar Series17
Coding for DiabetesNotes/Comments/QuestionsCoding Diabetes Diabetes-Associated NeurologicalComplications - 250.6 Polyneuropathy (many nerves) – 357.2Autonomic neuropathy – 337.1Gastro paresis (delay in gastric emptying) – 536.3Mononeuropathy (one nerve) – 354.0-355.9Neurogenic arthropathy (joint destruction) – 713.5Amyotrophic (muscle wasting) – 358.1 changed to353.1 (2008)35NephropathySmall blood vessels in the nephrons of the kidneysare damaged- nephrons are the filtering units ofthe bloodHypertension markedly accelerates progression ofdiabetic nephropathyThere are NO early warning symptomsMicroalbumin in the urine is the earliest clinicalevidence of kidney damage- screen annuallynormal- 30 microgm/mgpositive- between 30- 300clinical albuminuria (protein) 300AHIMA 2008 Audio Seminar Series3618
Coding for DiabetesNotes/Comments/QuestionsPrevent/Delay Nephropathy Blood Glucose control Blood Pressure control 130/80 mm Hg ACE inhibitors/ARBs -anti hypertensive drugs Normalize protein in diet37Coding Diabetic Nephropathy If the diagnosis does not state a cause and effectrelationship between diabetes mellitus and chronicrenal failure or chronic uremia the code for chronicrenal failure (585.9) may be assigned as theprincipal or first listed code.Example:585.9, Chronic renal failure250.0X, Diabetes Mellitus without mention of complication If the diagnosis provides a cause and effectrelationship, such as diabetic chronic renal failure,code 250.4X, Diabetes with renal manifestations, isrequired to be sequenced first.Example: Chronic renal failure due to Type 1 diabeticnephropathy is coded 250.41, 583.81 and 585.9Reference: AHA CC 2005 4Q, 2003 1Q, 1991 3Q, 1984-Sept-OctAHIMA 2008 Audio Seminar Series3819
Coding for DiabetesNotes/Comments/QuestionsCoding Diabetic NephropathyChronic renal failure due to diabetic nephropathyin a patient with hypertension is coded: 250.40, Diabetes with renal manifestationstype II or unspecified type not statedas uncontrolled403.90, Hypertensive chronic kidney diseasewith chronic kidney disease, unspecified585.9, Chronic kidney disease, unspecifiedReference: AHA CC 2006 4Q, 2005 4Q, 2003 1Q39Coding for Diabetes DM Renal / Kidney Complications - 250.4Chronic Kidney Disease – 585.XStage I 585.1Stage II (mild) 585.2Stage III (moderate) 585.3Stage IV (severe) 585.4Stage V (chronic) 585.5ESRD 585.6Chronic kidney disease (CKD) 585.9 or CKDunspecified (chronic renal failure insufficiency)40AHIMA 2008 Audio Seminar Series20
Coding for y Small blood vessels in the retina are damagedretina is the thin, fragile lining in the back of theeyeMost frequent cause of new blindnessThere are NO early warning symptomsScreening exam for early detection- annualdilated eye exam42AHIMA 2008 Audio Seminar Series21
Coding for DiabetesNotes/Comments/QuestionsLaser SurgeryDiabetic Retinopathy43Diabetic Retinopathy44AHIMA 2008 Audio Seminar Series22
Coding for DiabetesNotes/Comments/QuestionsCoding for Diabetes Diabetes-Associated ComplicationsOphthalmic Manifestations – 250.5Cataract 366.41Glaucoma 365.44Macular edema 362.07Retinal edema 362.07 plus retinopathyDiabetic Retinopathy 362.01 - 362.0745Coding for DiabetesDiabetes-Associated Eye Complications - 250.5 Background diabetic retinopathy - 362.01Proliferate diabetic retinopathy - 362.02Nonproliferative diabetic retinopathy - 362.03Mild nonproliferative diabetic retinopathy - 362.04Moderate nonproliferative diabetic retinopathy - 362.05Severe nonproliferative diabetic retinopathy - 362.06Diabetic macular edema - 362.07 *46AHIMA 2008 Audio Seminar Series23
Coding for DiabetesNotes/Comments/QuestionsCoding Diabetes GuidelinesDiabetic retinopathy/diabetic macular edema Diabetic macular edema, code 362.07, is only presentwith diabetic retinopathy. Another code fromsubcategory 362.0, Diabetic retinopathy, must be usedwith code 362.07. Codes under subcategory 362.0 arediabetes manifestation codes, so they must be usedfollowing the appropriate diabetes code. Diabetic macular edema, code 362.07, is only presentwith diabetic retinopathy. Another code fromsubcategory 362.0, Diabetic retinopathy, must be usedwith code 362.07. Codes under subcategory 362.0 arediabetes manifestation codes, so they must be usedfollowing the appropriate diabetes code.47Type 2 Pharmacological TherapySecretagoguesSulfonylureas-glimepiride (Amaryl)glyburide (Diabeta, Micronase, Glynase)glipizide (Glucotrol)Meglitinides-repaglinide (Prandin)nateglinide (Starlix)Insulin SensitizersBiguanides-metformin (Glucophage)Thiazolidinediones- pioglitizone (Actos)rosiglitizone (Advandia)Delayed Glucose AbsorptionAlpha glucosidase Inhibitors- acarbose (Precose)meglitol (Glyset)48AHIMA 2008 Audio Seminar Series24
Coding for DiabetesNotes/Comments/QuestionsType 2 Pharmacological TherapyCombination oral agentsGlucovanceMetaglipActoplus metAvandametAvandarylduetactDPP-4 Inhibitorsitagliptin (Januvia)Incretin mimetic- injectionexenatide (Byetta)49Type 1 & 2 Pharmacological TherapyFast and rapid acting insulin- bolus insulinregular (Humulin R, Novolin R)lispro (Humalog)aspart (NovoLog)glulisine (Apidra)Intermediate and long acting insulin- basal insulinNPH (Humulin N, Novolin N)glargine (Lantus)detemir (Levemir)combinations:Humulin 70/30 and 50/50, Novolin 70/30Humalog mix 75/25NovoLog mix 70/30amylin analogpramlintide (Symlin)AHIMA 2008 Audio Seminar Series5025
Coding for DiabetesNotes/Comments/QuestionsHistory of Pumps51Coding Diabetes GuidelinesOverdose of insulin due to insulin pumpfailure The principal or first listed code for anencounter due to an insulin pump malfunctionresulting in an overdose of insulin, should alsobe 996.57, Mechanical complication due toinsulin pump, followed by code 962.3, Poisoningby insulins and anti-diabetic agents, and theappropriate diabetes mellitus code based ondocumentation.52AHIMA 2008 Audio Seminar Series26
Coding for DiabetesNotes/Comments/QuestionsCoding Diabetes GuidelinesInsulin pump malfunction(a) Under dose of insulin due to insulin pump failureAn under dose of insulin due to an insulin pumpfailure should be assigned 996.57, Mechanicalcomplication due to insulin pump, as the principalor first listed code, followed by the appropriatediabetes mellitus code based on documentation.53Coding for DiabetesA type I diabetic patient is treated due to diabeticketoacidosis. The patient’s insulin pumpmalfunctioned during the night and stoppeddelivering insulin.Answer and Code Assignment:996.57, Mechanical complication of other specifiedprosthetic device, implant, and graft, due toinsulin pumpAssign code 250.13, Diabetes with ketoacidosis,type 1 uncontrolled54AHIMA 2008 Audio Seminar Series27
Coding for DiabetesNotes/Comments/QuestionsInpatient ConcernsUncontrolled Diabetes or Hyperglycemiasame liabilityHyperglycemia in the HospitalDiabetes-previously diagnosedunrecognized- undiagnosedStress hyperglycemia55The Hospitalized PatientHospitalizationsCostsLOSMortality56AHIMA 2008 Audio Seminar Series28
Coding for DiabetesNotes/Comments/QuestionsLength of Stay ComparisonPatients with no diabetes/indicatorsALOS 5.0 daysPatients with “250” dx codeALOS 6.9 daysPatients with no “250” dx codeon diabetes meds & BG 180ALOS 9.6 days(63% of total admits)(25% of total admits)(12% total admits)Approx. 40% of total admits have diabetesand/or indicatorsOlson, 2000, INTEGRIS Baptist, OK57Polling Question #3With approx. 40% of total admitshaving diabetes and/or indicators,which of the following documented signs andsymptoms in a medical record may indicate apatient has diabetes?*1 Extended length of Stay*2 Diabetic Medication IV, Subcut, Oral*3 Signs and symptoms of diabetes*4 Blood Glucose 100 mg/dL*5 Lab or FSBS values above 180*6 All of the above58AHIMA 2008 Audio Seminar Series29
Coding for DiabetesNotes/Comments/QuestionsPhysician Query ProcessReported codes must be supported byphysician documentation. Abnormal findings are not coded andreported unless the physicianindicates their clinical significance 59Deaths Among Hospitalized Patients12 / 1000No diabetes diagnosis27 / 1000Diabetes diagnosis known40 / 1000Unrecognized diabetesWhitehall 1988New hyperglycemia16 %Known diabetes3%Normoglycemia1.7 %Umpierrez 200260AHIMA 2008 Audio Seminar Series30
Coding for DiabetesNotes/Comments/QuestionsDocumentation and CodingOne major hospital chart review:7%– Diabetes diagnosis mentioned27% – Hyperglycemia mentioned66% – No mention of diabetes orhyperglycemiaOlson, INTEGRIS, 200061BG Control for Hospitalized PatientsIntensive Care 110 mg/dLNon- critical Care Units 110 preprandial 180 maximumPre-labor and Labor &Delivery 100 preprandial 120 one hour PPACE Consensus Conference Position Statement 200362AHIMA 2008 Audio Seminar Series31
Coding for DiabetesNotes/Comments/QuestionsBG Control in Hospital affected by: Increased insulin resistanceCorticosteroids (ie. Prednisone, SoluMedrol, etc.)InfectionTPN (Total Parenteral Nutrition) and TubeFeedingsChanging IV glucose ratesDecreased physical activityUnusual timing of insulin injections/ mealsUnder use of protocols, overuse of slidingscale insulin63Better OutcomesMortalityInfectionsSepsis DSWIBlood transfusionsRenal replacement therapyVentilator useCritical illness neuropathyAntibioticsLOSICU stayAHIMA 2008 Audio Seminar Series6432
Coding for DiabetesNotes/Comments/QuestionsAcute ComplicationsDiabetic Ketoacidosis (DKA)associated with type 1Hyperosmolar Hyperglycemic State (HHS)associated with type 265Diabetic Ketoacidosis (DKA)KetosisMetabolic acidosisHyperglycemiaDehydrationDKA Signs & Symptoms3 “Polys”- polyuria, polydypsia, polyphagiaplusNausea, vomiting, abdominal pain, “acute abdomen“Kussmaul respirationsAcetone breathu drowsiness leading to comaSigns of dehydrationAHIMA 2008 Audio Seminar Series6633
Coding for DiabetesNotes/Comments/QuestionsDKA Clinical FindingsKetones positiveSerum osmolality variableBG 250Serum K low, normal, highAcidosisNa normal, low, high pH 7.2 bicarb 15 pCO2 15-20 anion gap 12Fluid deficit approx. 3-7 liters67DKA Goals of Therapy1st Correct acidosis2nd Normalize blood glucose3rd Correct fluid deficit4th Balance electrolytes5th Prevent reoccurrenceDKA ManagementInsulinFluidsPotassiumBicarbonate68AHIMA 2008 Audio Seminar Series34
Coding for DiabetesNotes/Comments/QuestionsDiabetic CodingDiabetic ketoacidosisDiabetic ketoacidosis (DKA) is coded to 250.13with ketoacidosis type I (juvenile type),uncontrolled. It is uncontrolled by definitionCode 250.13 is the default, unless the physicianspecifically documents type II. Prior to 7/15/06DKA was coded to 250.11 unless specificallyidentified as NIDD 250.10.Reference: AHA CC, 2Q, 2006 pgs 19-20; CC, 3Q, 1991, pgs 6-769Diabetic CodingHyperosmolarity/diabetesDiabetes with Hyperosmolarity (increase inthe concentration of the blood) is coded250.2x.Reference: AHA CC, 4Q, 1993, pg 19; CC, 3Q, 1991, pg 770AHIMA 2008 Audio Seminar Series35
Coding for DiabetesNotes/Comments/QuestionsHHS Key CharacteristicsSevere hyperglycemiaMarked dehydrationNeurological changesAbsent or slight ketonesHHS Signs & SymptomsDecreased mentation or confusionLethargyFocal neuro signs- looks like strokeStupor, coma71HHS Clinical Findings BG 600 mg/dL Ketone bodies absent or small Serum osmolality 320 mOsm/L Fluid deficit 6-12 liters Serum K low, normal, high Na low, normal, high72AHIMA 2008 Audio Seminar Series36 page
Diabetes mellitus is a significant complicating factor in pregnancy. Pregnant women who are diabetic should be assigned code 648.0x, Diabetes mellitus complicating pregnancy, and a secondary code from category 250, Diabetes mellitus, to identify the type of
AHIMA's Data Quality Management Model "Data Quality Management Model (2015 Update)" Journal of AHIMA 86 . AHIMA Information Governance Adoption Model for Healthcare AHIMA www .
Bruksanvisning för bilstereo . Bruksanvisning for bilstereo . Instrukcja obsługi samochodowego odtwarzacza stereo . Operating Instructions for Car Stereo . 610-104 . SV . Bruksanvisning i original
AHIMA 2008 Audio Seminar Series ii Donna Wilson, RHIA, CCS Donna Wilson is the Revenue Integrity Manager for Roper St. Frances Healthcare, Charleston, SC. Donna has served on several AHIMA and other national workgroups to define coding practices and is a distinguished member of the SCHIMA.
AHIMA 2007 Audio Seminar Series ii Kathleen E. Wall, MS, RHIA, CPUR Kathleen is a Project Manager with 3M Consulting. She has 30 years of experience in Health Information Management, including coding and data quality. Kathleen is responsible for coordinating and managing DRG ASSURANCE projects, coding validations, Compliance Coding
Bruce W. Bode, MD, FACE Atlanta Diabetes Associates Atlanta, Georgia American Diabetes Association. Facts and Figures. Available at: http://www.diabetes.org/ada/facts.asp. Accessed January 18, 2000. Diagnosed Type 1 Diabetes 0.5 - 1.0 Million Diagnosed Type 2 Diabetes 10.3 Million Undiagnosed Diabetes 5.4 Million Prevalence of Diabetes in the US 3
Coding Laboratory Services AHIMA 2009 Audio Seminar Series 3 Notes/Comments/Questions Lab Coding Tips Select Accurate 80000 Codes Adjectives and othe r important words Specimen , Method, Total or Free, With or W/out Manual or automated, Qual or Quant, initial, Each, first, “2-8” or “9-15” Antibody codes start with 86xxx; Antigens
Benchmarking Coding Quality AHIMA 2008 Audio Seminar Series 4 Notes/Comments/Questions Current State - Survey Findings Coding errors due to physician documentation Vague documentation that leads to nonspecific code assignment or the need to query
10 tips och tricks för att lyckas med ert sap-projekt 20 SAPSANYTT 2/2015 De flesta projektledare känner säkert till Cobb’s paradox. Martin Cobb verkade som CIO för sekretariatet för Treasury Board of Canada 1995 då han ställde frågan
