ggparker14
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Is there a diagnosis for stable hypo blood sugars?
Any help is appreciated.
Any help is appreciated.
Stable is not the same as resolved. Even in a follow-up situation, the physician is evaluating an ongoing condition that is present, but stable. Just like angina-stable or HTN-stable...or as a stretch...DM-controlled...we code as a current condition. Therefore, I agree with the 251.2 code. In the index, go to Sugar, blood, low (hypo). Even though it maps to the same code as hypoglycemia, following precisely what the physician wrote is correct.
If the physician would have wrote "resolved", I would agree to the V67.9.
Just because the alpha index will lead you to a code does not necessarily mean it is the correct one. You can do the same thing with low hemoglobin and it will take you to anemia, which we cannot code if the physicians only documentation is low hemoglobin. He says stable hypo blood sugar is not the same thing as state the patient is diabetic or hypoglycemic, we need more documentation or we cannot code anything but possibly a followup type of code.
Low blood sugar is not a definition of hypoglycemia, it must be abnormally low for one thing. You as the coder are not allowed to make the determination that the blood sugar result is abnormally low. For the provider to remark that the blood surgar was low is not the same thing as the provider stating the patient has hypoglycemia. There are many other factors the provider considers as well, other symptoms such as faintness, confusion, headache, diaphoresis and so on. The provider goes thru testing then to determine cause and diagnosis. In this case the treatment provide stabilized the blood sugar and all is well, but the statement provided did not say the dx was hypoglcemia. You can say that all persons with hypoglcemia have low blood sugar but not that all persons with low blood sugar have hypoglycemia.
BTW Medical text book definition of hypoglycemia is an abnormally low blood sugar accompanied by symptoms that may incude faintness, tremors, nervousness, diaphoresis, motor weakness, palsy, ataxia, maked personality changes, etc.
First I do not assume anything, I suggested a followup code as opposed to assigning a dx not documented. I honestly feel there is not enough information to assign a diagnosis and I would query the physician for more information. It is possible the original poster has more information and has not posted it. I was not suggesting we make any determination given signs and symptoms, I only listed that to show there is more to a diagnosis of hypoglycemia than a low blood sugar result. The definition states the result must be abnormally low and we have no way of knowing if a statement of hypo blood sugar is abnormally low or just low. What I am saying is we cannot assign a diagnosis not rendered. The 251.2 code is not a code for a low blood sugar reading it is a code for a diagnosis of hypoglycemia and they are are not interchangeable terms. The chapter title as well as the category heading do have meaning and must be adheared to... I do understand why Behcets disease is located in the infectious and parasitic diseases chapter, and it is in the correct place.
ICD codes are created by the CDC, by a physicians and specialists that study diseases and disease processes the book is their design. We cannot change the definition or placement of a code.
I am sorry to disagree with everyone but speaking from the experience of having been given a diagnosis of hypoglycemia when it was not documented and anemia when it was not documented, I am saying if it is not documented we cannot code it. What we were given was stable hypo blood sugar and that is not the same thing as 251.2. Perhaps more information is what is called for.
This may be a little late, but I wanted to add my input to this discussion.
The initial post asks for a diagnosis code for "stable hypo blood sugars" and includes no other information/documentation. That being said, I agree with Debra. Unless there is more information included in the note that we do not have, the doctor is not giving a diagnosis of hypoglycemia. Let me explain why...
In those treated for diabetes, a diagnosis of hypoglycemia can be made based on the presence of a low blood sugar alone. Otherwise, Whipple's triad is required which include symptoms consistent with hypoglycemia, a low blood sugar, and resolution of these symptoms once the blood sugar improves.
Unless this patient is a diabetic, we cannot assign code 251.2 from the stated documentation alone.
Also, you arrived at the conclusion of hypoglycemia by looking through the index, starting at sugar. However, if you go to the index listing under Decrease, decreased (aka hypo) and look down at glucose, it gives you the code 790.29. Upon viewing the Tabular List, you can see that this code is listed as Other abnormal glucose. This code is also the code used for a patient with elevated glucose, in which no formal diagnosis of Diabetes is given. In this case, it is low glucose in which no formal diagnosis of Hypoglycemia was given.
I wanted to add that "stable" denotes, to me, that even coding 790.29 may not be the correct code selection. It seems TO ME, that a V-code would be the best choice for this scenario.
Again, we do not have the full story, as there is probably more documentation in the note that we have not seen. The best option is to query the physician.
So, with that, I respectfully disagree with assigning code 251.2 to the the written documentation.
My two cents again... hypo does not mean decrease or decreased... hypo prefix means low, under, beneath, down or below normal. No where does hypo definition state decrease or decreased. Based on the only documentation that we have available, which is stable hypo blood sugars, it is 251.2.
The signs and symptoms of hypoglycemia may not always be evident at specific blood glucose levels. Individual variations may explain why some patients show symptoms at blood glucose levels that would be considered low but normal. However, in order for hypoglycemia to be conclusively be diagnosed, it should meet with the three criteria as outlined in Whipple's triad.
These three criteria help to identify borderline hypoglycemia :
Signs and symptoms of hypoglycemia (listed below).
Low plasma glucose – blood glucose level below 54mg/dL (3mmol/L) in non-diabetics and 63mg/dL (3.5mmol/L) in diabetics.
Resolution of symptoms once the blood glucose levels rise.
Signs and Symptoms of HypoglycemiaThe signs and symptoms of hypoglycemia can be divided into two categories :
1. Autonomic
2. Neuroglycopenic
There are are also general and non-specific signs and symptoms which should not be used in isolation to diagnose hypoglycemia. These general symptoms include nausea, fatigue, and headaches. Often the term ‘low blood sugar' is used frivolously to explain the cause of these symptoms although other causes could account for it.
Autonomic
When the blood glucose levels drop significantly, the body releases epinephrine. This triggers certain processes like releasing the glucose stored in the liver (glycogen) in an attempt to stabilize the blood glucose levels. Epinephrine also affects the nervous system and results in these characteristic signs and symptoms :
Anxiety
Dizziness
Hunger
Palpitations
Sweating
Trembling
These symptoms are the early warning signs but may be absent in certain cases. In patients who experience frequent episodes of hypoglycemia, the body may stop releasing epinephrine. This is known as hypoglycemic-associated autonomic failure (HAAF) or is also referred to as hypoglycemia unawareness. The blood glucose levels continue to drop until the neuroglycopenic symptoms may be evident. It may only be at this point that the appropriate measures are implemented.
Neuroglycopenic
As the blood glucose levels continue to drop without any intervention, the glucose supply to the brain is severely impaired and may result in the symptoms listed below.
Blurred vision
Confusion
Difficulty concentrating
Drowsiness
Irritability, anger
Poor coordination
Speech difficulty
Eventually seizures and even a coma may ensue. Changes in behavior at this stage may resemble inebriation (alcohol intoxication, drunkeness) and is sometimes mistaken for alcohol dementia in alcoholics.
This has been a very interesting discussion - with both sides supporting their thoughts. After reviewing what was said, coupled with my feelings - I first thought that the best code would be 790.29 - because the patient has low blood sugar without dx of hypoglycemia. However, I am leaning more towards the V code now because the original poster states the condition is stable. If the patient was not diagnosed with hypoglycemia, but had an episode of low blood sugar and it is now stable, then the condition is no longer being treated - it is a follow-up.
I wonder what happened to the original poster of this question...maybe they could have provided more information from the notes to assist everyone in coming up with a consistent answer for their question!
Have a nice day all!
Glad you joined the discussion! I don't think (again my opinion) that you can use a V code in this situation because he states it it stable. Stable does not mean no longer being treated. Just like you can have stable hypertension.. you still have hypertension... not a history of. If it was no longer being treated then he would have said resolved, not stable. Again, just my opinion
I wanted to add that "stable" denotes, to me, that even coding 790.29 may not be the correct code selection. It seems TO ME, that a V-code would be the best choice for this scenario.
Again, we do not have the full story, as there is probably more documentation in the note that we have not seen. The best option is to query the physician.
So, with that, I respectfully disagree with assigning code 251.2 to the the written documentation.
This has been a very interesting discussion - with both sides supporting their thoughts. After reviewing what was said, coupled with my feelings - I first thought that the best code would be 790.29 - because the patient has low blood sugar without dx of hypoglycemia. However, I am leaning more towards the V code now because the original poster states the condition is stable. If the patient was not diagnosed with hypoglycemia, but had an episode of low blood sugar and it is now stable, then the condition is no longer being treated - it is a follow-up.
I wonder what happened to the original poster of this question...maybe they could have provided more information from the notes to assist everyone in coming up with a consistent answer for their question!
Have a nice day all!