Criteria For Dka

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Diagnosis Coding When You Can and Cannot Code the Diagnosis http://www.cco.us/medical-terminology... One of the questions that we get from new students is knowing when you can and cannot code the diagnosis. I think a lot of students, as soon as they learn how to look up codes, they are ready to code everything that they see. And every new student does it. I remember I did it. I wanted to call myself a supercoder because I wanted to code everything. It's fun to code. But you can't do that. You need to code only definitive diagnoses and they can be hard to identify. One of the things that you have to stay away from is equivocal language. When we say equivocal language, that means it's kind of on the fence. It's not a definite. It can go one way or the other. You have to stay away from that type of verbiage. Impending or threatened conditions, you'll see that, but that can be tricky. You cannot code something if it has not happened yet, in most cases. Now I know that sounds again, a little ambiguous, but if your physician documents, for example, we'll scroll down here just a bit... impending rupture of spleen due to enlarged spleen. Okay, impending tells you it's going to happen. They're pretty sure it's going to happen but it hasn't happened yet. So you cannot code a ruptured spleen. You can only code the splenomegaly which is an enlarged spleen, 789.2. That's the proper code to use. Now I've got some more examples for you, so we'll scroll down and look at some of these others. Okay if your physician documents something like this -- Mrs. Jones is seen today with lower abdominal pain and spotting. I will admit her for a threatened miscarriage. So you're now saying to yourself, "Well, she hasn't had a miscarriage. It hasn't happened yet." But in actuality, there's a code for this because it's such a common event. You can, however, code 640.0 and you'll need a fifth digit. It does not matter that the miscarriage has not occurred yet. There is a code for a threatened miscarriage because that is a medical condition. If there had not been a code for that then you would have to code the signs and symptoms, just the spotting and the abdominal pain. Okay, we've got some more things to look at here, words that you want to pay attention to. "Possible, maybe, suspect, rule out, probable, expect, apparent, perhaps, conceivably, plausibly". Now if you're coding and you're coding in an office that you have repetitious documents from specific doctors and you see them all the time, you'll learn what verbiage they use. But if you're doing something like remote coding or multiple physicians, it may be a little harder and you have to kind of get to know how they like to document, how they like to word things. These are some words that just popped up in one day of remote coding that I was doing and it gets to be kind of humorous sometimes where you have to do a second take and say, "What did they say? They said maybe?" So scroll down just a little bit more. I've got some more examples. Okay, these terms mean your physician does not know or is waiting for more testing. If the statement is made, this is another little case -- Mr. Green has been feeling tired, thirsty and is making frequent trips to the bathroom. It's apparent he has DM since his father and mother both had DM by age 50. We will draw labs today. He is to return in one week for the results. Now, the fact that he said it's apparent he has diabetes, he didn't actually say that he has diabetes. He said it's apparent that he has diabetes. And then he confirms that he's not sure because he's going to do a test and have him come back for the results. You have to be very careful. If you gave this gentleman diabetes with the way you coded, it's going to follow him for the rest of his life. And he could have problems in the future, maybe even getting jobs or life insurance policies because they do look at your medical information to determine stuff like that. So you have to be very, very careful. He might just have a bad cold and be real thirsty. Get more medical coding training,, medical coding tutorial, medical coding tips, medical coding certification, and free medical coding webinars at http://www.cco.us/cco-yt https://youtu.be/yMGz3ctOKaA


Print If your doctor suspects diabetic ketoacidosis, he or she will do a physical exam and various blood tests. In some cases, additional tests may be needed to help determine what triggered the diabetic ketoacidosis. Blood tests Blood tests used in the diagnosis of diabetic ketoacidosis will measure: Blood sugar level. If there isn't enough insulin in your body to allow sugar to enter your cells, your blood sugar level will rise (hyperglycemia). As your body breaks down fat and protein for energy, your blood sugar level will continue to rise. Ketone level. When your body breaks down fat and protein for energy, acids known as ketones enter your bloodstream. Blood acidity. If you have excess ketones in your blood, your blood will become acidic (acidosis). This can alter the normal function of organs throughout your body. Additional tests Your doctor may order tests to identify underlying health problems that might have contributed to diabetic ketoacidosis and to check for complications. Tests might include: Blood electrolyte tests Urinalysis Chest X-ray A recording of the electrical activity of the heart (electrocardiogram) Treatment If you're diagnosed with diabetic ketoacidosis, y Continue reading >>

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  1. RedWingNut

    Wow, got them 50/box for $11. They are the Walgreens brand but work great. Initially I wasn't going to bother checking my ketone levels but curiosity got the best of me! Loved seeing that itty bitty stick change colors!

  2. msheaven

    I got a 100 stick bottle on amazon for 12 bucks... used one stick, went to the dr and got put on antibiotics... sighs... my ketostix are a 10 part unrinalysis stix and I had wbc, rbc, protein, specific gravity and some other things show up..
    didn't tell the dr I self dx'd just said I thought I had a bladder infection or something... they had me pee in a cup and then put me on bactrim

  3. RedWingNut

    Way better deal! Sorry about your UTI

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How to Present a Patient: Series for Medical Students Texas Tech University Health Sciences Center School of Medicine in Lubbock Ashley, 2 Weeks, Female

Episode 63 – Pediatric Dka

Pediatric DKA was identified as one of key diagnoses that we need to get better at managing in a massive national needs assessment conducted by the fine folks at TREKK – Translating Emergency Knowledge for Kids – one of EM Cases’ partners who’s mission is to improve the care of children in non-pediatric emergency departments across the country. You might be wondering – why was DKA singled out in this needs assessment? It turns out that kids who present to the ED in DKA without a known history of diabetes, can sometimes be tricky to diagnose, as they often present with vague symptoms. When a child does have a known history of diabetes, and the diagnosis of DKA is obvious, the challenge turns to managing severe, life-threatening DKA, so that we avoid the many potential complications of the DKA itself as well as the complications of treatment – cerebral edema being the big bad one. The approach to these patients has evolved over the years, even since I started practicing, from bolusing insulin and super aggressive fluid resuscitation to more gentle fluid management and delayed insulin drips, as examples. There are subtleties and controversies in the management of DKA when Continue reading >>

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  1. asmith79

    Diabetes, type 2, uncontrolled for I-10

    I am looking for any information on coding Diabetes, Type 2, uncontrolled for ICD 10. In a recent educational discussion there was some confusion on which was the appropriate code to use, E11.9 or E11.65. The thought behind E11.65 is that the terms "uncontrolled" and "out of control" have the same meaning. When you look in the alpha index under diabetes, out of control, ( page 95) , it directs you to code "Diabetes, specificed type, with hyperglycemia" which would take you to E11.65.
    Does anyone have any information that could help clarify this? Anything would be appreciated!

  2. Amy Pritchett

    The ICD-10-CM page 95 states "Diabetes inadequately controlled using hyperglycemia" see by type. Therefore, if the patient is type II you would code E11.65 which is the inadequately controlled portion, type II.
    Hope this helps

  3. asmith79

    Thank you amy, that is my thought as well. However, the argument i am hearing is that if the note just states "uncontrolled", how are we to determine if it is hypo or hyper? The e11.65 specifically states hyper. There is also arguments that "uncontrolled" and "out of control" do not mean the same thing.

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What is DIABETIC KETOACIDOSIS? What does DIABETIC KETOACIDOSIS mean? DIABETIC KETOACIDOSIS meaning - DIABETIC KETOACIDOSIS definition - DIABETIC KETOACIDOSIS explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness. A person's breath may develop a specific smell. Onset of symptoms is usually rapid. In some cases people may not realize they previously had diabetes. DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances. Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids. DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies. DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine. The primary treatment of DKA is with intravenous fluids and insulin. Depending on the severity, insulin may be given intravenously or by injection under the skin. Usually potassium is also needed to prevent the development of low blood potassium. Throughout treatment blood sugar and potassium levels should be regularly checked. Antibiotics may be required in those with an underlying infection. In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended. Rates of DKA vary around the world. About 4% of people with type 1 diabetes in United Kingdom develop DKA a year, while in Malaysia the condition affects about 25% a year. DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost universally fatal. The risk of death with adequate and timely treatment is currently around 1–4%. Up to 1% of children with DKA develop a complication known as cerebral edema. The symptoms of an episode of diabetic ketoacidosis usually evolve over a period of about 24 hours. Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that may be severe. Those who measure their glucose levels themselves may notice hyperglycemia (high blood sugar levels). In severe DKA, breathing becomes labored and of a deep, gasping character (a state referred to as "Kussmaul respiration"). The abdomen may be tender to the point that an acute abdomen may be suspected, such as acute pancreatitis, appendicitis or gastrointestinal perforation. Coffee ground vomiting (vomiting of altered blood) occurs in a minority of people; this tends to originate from erosion of the esophagus. In severe DKA, there may be confusion, lethargy, stupor or even coma (a marked decrease in the level of consciousness). On physical examination there is usually clinical evidence of dehydration, such as a dry mouth and decreased skin turgor. If the dehydration is profound enough to cause a decrease in the circulating blood volume, tachycardia (a fast heart rate) and low blood pressure may be observed. Often, a "ketotic" odor is present, which is often described as "fruity", often compared to the smell of pear drops whose scent is a ketone. If Kussmaul respiration is present, this is reflected in an increased respiratory rate.....

Refining The Diagnostic Criteria For Diabetic Ketoacidosis

Refining the Diagnostic Criteria for Diabetic Ketoacidosis Current consensus criteria for Current consensus criteria for a diagnosis of diabetic ketoacidosis (DKA) include the presence of ketonuria/ketonemia, a serum bicarbonate (HCO3) [le] 18 mEq/L, a pH [le] 7.30, and a glucose [gt] 250 mg/dL. These diagnostic criteria have limitations, however. Measurement of ketone bodies (KB) by the conventional nitroprusside method is not quantitative. Moreover, HCO3 and pH lack sensitivity and specificity due to coexisting acid-base disturbances (e.g., lactic acidosis, renal acidosis, and/or metabolic alkalosis due to HCl loss from vomiting) and variable respiratory compensation. On the other hand, plasma KB anion concentration is a specific indicator of DKA because it is a direct reflection of KB production, which is accompanied by equimolar production of hydrogen ion. In the present study, we sought to develop a diagnostic criterion for DKA using a laboratory-based [beta]-hydroxybutyrate ([beta]OHB) assay, and to evaluate the degree of diagnostic discordance between [beta]OHB and HCO3. Data were retrieved electronically by ICD-9 code and for simultaneous measurement of [beta]OHB and HCO3. Continue reading >>

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  1. cuteblonde

    can the menstrual cycle affect weight loss and ketosis? i've been doing atkins for three and a half weeks now. i lost 7 pounds after the first 2 weeks but during the third week (week of period) i gained 2 pounds back. could this be water retention even though i'm downing tons of water or hormone fluctuation? also, all this time i've been in ketosis with my strips turning dark purple. well the past 2 days (right after starting my period) i've suddenly been knocked out of ketosis. i've only added some macadamia nuts (one serving's worth at 4 carbs) and herbal tea. the tea is celestial seasonings and has 0 carbs, calories, etc. and no caffiene. but i had been consuming these 2 things for a week before suddenly my strips stopped turning purple. monday night they were dark purple and tuesday night they were barely pink. so what's the deal with this? i have never consumed more than 25 carbs on any day. i'm not focusing so much on my weight anymore. instead i like to have evidence that i'm in ketosis by having purple strips. so since they are barely pink all of a sudden does that mean i've suddenly stopped burning fat? i'm not going to stop because i feel better, but it is frustrating.

  2. Skamito

    Okay... first of all, YES! Hormones and menses can and will affect what the scale and probably also what the ketosis testing says. Don't let water retention bum you out. It is not fat gained and will pass. Just keep drinking that water and you should be fine.
    As for the ketosis strips, my best advice (though perhaps hasty) is don't use them. They are infamously unreliable and I don't trust em as far as I can throw em. Here are some things that can affect them:
    -Exposed to air
    -Exposed to steam
    -Dietary fat
    -Water intake
    -Expulsion of ketones through breath, sweat as opposed to urine
    -Just plain defective
    That being said, pink is actually better than dark purple. Purple can mean you are dehydrated. Pink still indicates the presence of ketones, but they are diluted. That's good! Drink that water.
    Are you noticing the other feelings of ketosis? Distinct breath, dimished appetite, etc. are also ways of determing the fat burning state.
    Hope that helps a bit. The tea and macadamia nuts are fine additions and if you're not going above 25g of carbs a day, I assure you that you are in ketosis and will see results.
    I wish you good luck. I'm sure you will do well. :)

  3. cuteblonde

    well that does make me feel a lot better. it's easy to get hung up on one thing like ketone strips, weight, inches, etc. i do feel better and look better so that's what is truly important.

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