need help with diagnosis - Is there a diagnosis for stable
Just to be thorough, I went back to med terms 101 and come up with this explanation:
hypo: deficient, below, under, less than normal
glycemia: the presence of glucose in the blood
glucose: an optically active sugar
When put together we have hypoglycemia is the deficient/less than normal amount of sugar in the blood.
My final statement on this issue (because of less-entertaining work that I have to do): when the physician in the initial post stated "stable hypo blood sugar" he/she was referring to the current status of having low blood sugar (hypoglycemia) that is stable (not changing or fluctuating) and would require the 251.2 unspecified code and not a Vcode.
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.
Debra A. Mitchell, MSPH, CPC-H
The initial post did not include any of the signs or symptoms you are referring to under the definition of hypoglycemia. Does the patient in question suffer from these? We were not told. And even if we are told the s/s, when a diagnosis is made, we cannot code the s/s anyway. Hypo blood sugar is a valid, allowable diagnosis. This determine can only be made by an examination of blood.
Your initial comment in this thread was that sometimes a condition found in the index maps us to the wrong code in the tabular. My disagreement with that is what started this whole thing. Once a condition is found in the index, absolutely we are to look in the tabular to make sure we have the correct code to the highest specificity. As you know, sometimes are are guided to a 4th- or 5th- digit...sometimes to a "code underlying condition first" guideline...sometimes to a "code additional manifestation if known" guideline. I do not pretend to know what the physician who wrote "stable hypo blood sugar" meant to say...I only know what he did say. You are the one who initiated the comment that "this sounds like a follow-up encounter" so a Vcode could be used. Even that information was not given to make that assumption. In the definitions I cited from the Merriam-Webster's Medical Dictionary (revised edition, 2005), the definition of hypoglycemia was "an abnormal decrease of sugar in the blood". A pathophysiology textbook that I consulted states that "hypoglycemia is defined as a fasting glucose level less than 70 mg/dl. What does the textbook do for me with this question? Nothing. I was not given the lab report. So...we are not told the nature of the encounter, the s/s related to the diagnosis, nor the lab report to view the glucose levels.
All I know from the question asked was how to code "stable hypo blood sugar". My response to use code 251.2 is backed up with coding guidelines. For whatever reason the experts who put this whole system together guides us to use the same code for "low blood sugar" as we do for "hypoglycemia". The word "stable" means nothing from the coding perspective in relation to this diagnosis. When the physician is evaluating the status (yes, even stable) of a condition THAT IS STILL PRESENT but not changing/fluctuationg, we are to code as a current diagnosis.
Debra, I respectfully ask that you post exactly what code you would use. You gave a range of suggestions and arguments against a code, but nothing concrete with the rationale as to the exact code that you would use. I thrive on learning new things and if I am wrong on how to code stable hypo blood sugar, I welcome the correction.
You are so adament that we are not to believe that the low blood sugar code is the same as the hypoglycemia code as stated in our coding book, yet you assume that "In this case the treatment provide[d] stabilized the blood sugar and all is well". Where do you get that?? What treatment? Is all well?? If this were the case, why didn't the physician write "normal blood sugars"? I am not ASSUMING what the s/s are. I am not ASSUMING that treatment was administered. I am not ASSUMING all is well. I am CODING "stable hypo blood sugar" as written.
Originally Posted by mitchellde
What code would you assign to the diagnosis of "hypo blood sugar"?
Okay, my two cents for what they are worth. The CORRECT code is 251.2. Period, cut and dry. Something to think about. I have a rare autoimmune disease called "Behcet's disease or Behcet's Syndrome".. whatever you want to call it. In the ICD-9 book it has it listed under other and unspecified infectious and parasitic disease. I can tell you that it not infectious nor parasitic.... it is AUTOIMMUNE... same as lupus, rheumatoid arthritis, etc. Just because it is placed under the unspecified infectious and parasitic diseases in the book, does not MEAN it is an infectious and parasitic disease. Why they have it there, I do not know... maybe because it is so rare??? with only 15,000 Americans having it and they didn't know where else to put it? Who knows. All we can do is follow the correct path to the code. Just because the code is in a place that it should not be does not make it an incorrect code, same as if the code can have a different meaning... still the same code. Period.
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.
Last edited by mitchellde; 02-18-2011 at 04:06 PM.
Debra A. Mitchell, MSPH, CPC-H
removed because you are not worth my time nor energy.
Last edited by eadun2000; 02-18-2011 at 06:32 PM.
Reason: not worth my time
Let me state this for the record... according to 3M, AS WELL AS ICD-9 hypo blood sugar IS coded to 251.2.
Originally Posted by mitchellde
Last edited by eadun2000; 02-18-2011 at 09:23 PM.
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.
Vanessa Mier, CPC
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.
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