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Thread: Need help w/dx code - Pt admitted for altered mental status with elevated ammonia lev

  1. #1
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    Post Need help w/dx code - Pt admitted for altered mental status with elevated ammonia lev

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    Pt admitted for altered mental status with elevated ammonia level. Which is best code to use for elevated ammonia level?

  2. #2

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    Look at 270.6.
    Julianne Sheetz, CPC

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    Yes, 270.6.[elevated amounts of ammonia in the blood (hyperammonemia)].

    When adults experience mental changes, disorientation, sleepiness, or lapse into a coma, an ammonia level may be ordered to help evaluate the cause of the change in consciousness, it helps to diagnose the cause of a coma of unknown origin or to help support the diagnosis of Reye’s syndrome or hepatic encephalopathy caused by various liver diseases. An ammonia level may also be ordered to help detect and evaluate the severity of a urea cycle defect.

    In patients with stable liver disease, an ammonia level may be ordered, along with other liver function tests, when a patient suddenly “takes a turn for the worse” and becomes more acutely ill.

  4. #4

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    could you use 790.6 for elevated ammonia levles?

  5. #5

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    Code 270.6 is hyperammonemia (congenital), and we can only code 'congenital' if physician documents it as so. I think in this case-I would go with 790.6 "Abnormal Blood Chemistry". Thanks!

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    Quote Originally Posted by mrsshartucker View Post
    Code 270.6 is hyperammonemia (congenital), and we can only code 'congenital' if physician documents it as so. I think in this case-I would go with 790.6 "Abnormal Blood Chemistry". Thanks!
    Hmmmm....... There is nothing congenital about 270.6.
    270.6 Disorder of Urea Cycle, is a code from catergory
    270 Disorders of Amino-acid transport and Metabolism in the chapter
    Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders.

    All these must fit for the code to be selected, if the provider documents elevated ammonia levels it is not the same as hyperammonemia.
    hyperammonemia is an ABNORMALLY high level of ammonia in the blood, this is not the same as an elevated result. The coder cannot interpret for the provider, if the provider had wanted this diagnosis he/she would have documented it.
    An elevated lab result is only an abnormal lab.. 790.6

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
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    270.6 is for hyperammonemia, which falls under the Endocrine/Metabolic Disorders section. Although elevated levels of ammonia might infer that the patient has a metabolic disorder, I do not feel that this code should be used unless the provider states "hyperammonemia". "Hyper" does not always equal "elevated".
    We have historically used 790.99 for elevated ammonia. But now that I look into this again, 790.6 would be the appropriate code.
    I am interested to see what others are using.
    Last edited by bridgettemartin; 04-04-2013 at 08:19 AM.
    Bridgette Martin LPN, CPC, CEMC, CGIC

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