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need help with diagnosis - Is there a diagnosis for stable

  1. #21
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    Medical Coding Books
    Quote Originally Posted by eadun2000 View Post
    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.
    There are many synonyms for "hypo" including, but not limited to those that you have listed. For instance, per Stedman's Medical Dictionary, hypo- is defined as "Prefix denoting deficient, below normal". Decreased is, in fact, synonymous with hypo.

    Regardless of if you agree with that or not does not change the fact that Hypoglycemia, again defined per Stedman's Medical Dictionary, is "Symptoms resulting from low blood glucose (normal glucose range 60-100 mg/dL [3.3-5.6 mmol/L]), which are either autonomic or neuroglycopenic. Autonomic symptoms include sweating, trembling, feelings of warmth, anxiety and nausea. Neuroglycopenic symptoms include feelings of dizziness, confusion, tiredness, difficulty speaking, headache, and inability to concentrate."

    So, how exactly do you get that out of "stable hypo blood sugars"? You don't. I also urge you to look up "Whipple Triad".

    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.
    Again, I believe that if there is not already more documentation provided in the note, you should query the physician.
    Vanessa Mier, CPC

  2. #22
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    PS
    I'm, in no way, trying to get involved in a pissing contest of any sorts. I did not add my input to be rude, anger, or upset anyone. I firmly believe that this forum is a great assistance to all of us. There have been times where I have stated my input only to realize that I was previously misunderstanding and my point of view was wrong, plain and simple. The problem with forums like these is that many times, as we are all so passionate about our work, we are blind to the information being given because we believe we are right.

    When it comes down to it, this patient could very well be Hypoglycemic. However, there is not enough documentation posted to know that. To so strongly insist that your answer is THE definitive answer, when others disagree, kind of defeats the purpose of this forum.
    Vanessa Mier, CPC

  3. #23
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    I still fail to see how you correlate the statment "stable hypo blood sugar" to a diagnosis of hypoglycemia. It just does not make sense. The patient could be a diabetic that has been having a series of low blood sugar readings that needed to have their insulin adjusted, It could have been a reaction to an drug the patient was on and now the sugars have stablized. I am trying to convey the point that for a provider to make a remark about a low blood sugar ( which is all you have here) is not the same as the provider rendering a diagnosis of hypoglycemia.

    Debra A. Mitchell, MSPH, CPC-H

  4. Default
    The comments from coders not wanting to use the 251.2 code have something in common. We are being warned not to give a diagnosis of hypoglycemia because that is not what the physician said. I did NOT assign 251.2 by assuming the physician meant hypoglycemia and therefore I looked up hypoglycemia in the index and confirmed in the tabular. I DID however, come to the 251.2 code by looking in the index for EXACTLY what the physician wrote. As in a previous example I showed that "itch" guides us to an unspecified pruritis code. Do all itches mean pruritis? No. But if itch is all we have, the coding experts guide us to the pruritis category. Their reasoning...not mine.

    While it is the agreement that we cannot assume what the physician meant, it is my practice not to assume what he did not mean either. Stable is a descriptor for the physician's management of a condition. I would never argue that when a physician writes "hypertension-stable" he really means the patient is cured and assign a Vcode. Stable/unstable, controlled/uncontrolled are words describing a current condition that still needs monitored.

  5. #25
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    I want to point out that, though I DID in fact point out that we are not to assume what the physician means by what they are documenting rather we are to code exactly what is stated, that was not my only arguement. I also want to point out that, though the Index is there to guide us, we are NOT to code from the index. Starting from the time that I was studying to be a CPC in school, that is what I have ALWAYS been told.

    The dx is stable hypo (aka low) blood sugars, not hypoglycemia. There is more to Hypoglycemia than having low blood sugar readings. I posted that information already. If there is more to the documentation that points to Hypoglycemia, the orginal poster has not posted it.
    Vanessa Mier, CPC

  6. #26
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    Thank You Vanessa! While the index will lead you to the 251 code for the low blood sugar, as a coder you then need to determine if this is in fact the code you were looking for. The chapert the code is in, is it correct?, the category heading you find you code in does it apply? And in this case to code the patient as have an endorcrine disorder is not for us to say, there is not enough documenation. For instance, the patient is on anticoagulants and the index leads you to 964.2 which says anticoagulant, would you then use this code? or would you look to see that you are in the chapter for injury and poisoning, and a catergory for poisoning by agent. I think you would try a different search word! Alos a patient is fine and comes to the provider due to missed periods and a suspicion that they are preganant. would you look up missed periods or amenorrhea and get 626.0 and code that? Or would you look and see that you are in the chapter for diseases of the genitourinart system and a catergory for Disorders of menstruation and other abnormal bleeding from female genital tract, when the only thing is the patient has missed a couple of periods and thinks she is pregnant? you need to look for a different code as the chapter and the category are wrong for your scenario. Yes the index assists us with looking up codes but it is not infallible in where it takes us. We must use our skill and education as a coder to discern if the code found is the correct code for the documentation provided. So look at what is documented again and see what is being communicated. The diagnosis is the PATIENT'S and we have a duty and responsibility to be 100% CORRECT at all times!

    Debra A. Mitchell, MSPH, CPC-H

  7. Default
    I just say we can all agree to disagree on this one. Everybody has valid points and I can see where they are coming from. HOWEVER, I personally still stand by my code.. 251.2. I understand you do not agree and that is okay. That is just how I see it.

  8. #28
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    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!
    Jodi Dibble, CPC

  9. Default
    Quote Originally Posted by jdibble View Post
    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

  10. #30
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    Quote Originally Posted by eadun2000 View Post
    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
    That's true - stable is not gone. Then I would have coded the 790.29 - from the symptom section. Of course that is my opinion! I just feel that a little more info from the original poster should have been provided...they have not commented on this thread at all!!! I wonder what they ended up using?
    Jodi Dibble, CPC

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