Alcoholic Ketoacidosis
Increased production of ketone bodies due to: Dehydration (nausea/vomiting, ADH inhibition) leads to increased stress hormone production leading to ketone formation Depleted glycogen stores in the liver (malnutrition/decrease carbohydrate intake) Elevated ratio of NADH/NAD due to ethanol metabolism Increased free fatty acid production Elevated NADH/NAD ratio leads to the predominate production of β–hydroxybutyrate (BHB) over acetoacetate (AcAc) Dehydration Fever absent unless there is an underlying infection Tachycardia (common) due to: Dehydration with associated orthostatic changes Concurrent alcohol withdrawal Tachypnea: Common Deep, rapid, Kussmaul respirations frequently present Nausea and vomiting Abdominal pain (nausea, vomiting, and abdominal pain are the most common symptoms): Usually diffuse with nonspecific tenderness Epigastric pain common Rebound tenderness, abdominal distension, hypoactive bowel sounds uncommon Mandates a search for an alternative, coexistent illness Decreased urinary output from hypovolemia Mental status: Minimally altered as a result of hypovolemia and possibly intoxication Altered mental status mandates a search for other associated conditions s Continue reading >>
[email protected]
Dm 2 with ketoacidosis
I had a case to code a couple of days ago; patient had "diabetic ketoacidosis." There was no description as to the type of diabetes, so I went with type 2. At this point, I noticed there are combination codes for DM 1, DM due to drug or chemical, due to underlying condition and specified type NEC, but there is no combination code for DM 2 with ketoacidosis. I coded it as DM 2 with complication NEC E11.69 and Ketoacidosis E87.2. The doctor gave an additional diagnosis of lactic acidosis, which is also coded as E87.2. Does anyone have any insights on a better way to code this, or the rationale of not having a combination code for DM type 2 with ketoacidosis? (Incidentally, the patient also had urogenital warts, severe sepsis present on admission, and there was no mention of any kind kidney malfunction.)
[email protected]
I found an answer on another thread that indicated to go with "DM specified type NEC with ketoacidosis (without coma) E13.10" instead of DM 2 with complication NEC E11.69 and ketoacidosis E87.2 (even though the type of diabetes is not specified); seems strange, but I guess that's what I'll do if it ever comes up again.
rbandaru
Hello,
As per coding Clinic Diabetic with ketoacidosis code is E13.10 below is reference from coding Clinic.
Assign code E13.10, Other specified diabetes mellitus with ketoacidosis without coma, for a patient with type 2 diabetes with ketoacidosis. Given the less than perfect limited choices, it was felt that it would be clinically important to identify the fact that the patient has ketoacidosis. The National Center for Health Statistics (NCHS), who has oversight for volumes I and II of ICD-10-CM, has agreed to consider a future ICD-10-CM Coordination and Maintenance Committee meeting proposal
Regards
Dr.Ramnath Bandaru, CCS, CPC
American Medical Services LLC
http://amshealth.com/
Twitter: @HospitalCoders