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need help with diagnosis - Is there a diagnosis for stable

  1. #31
    Stuart, Florida
    Medical Coding Books
    Quote Originally Posted by ohn0disaster View Post
    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.
    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!
    I agree! I feel that it would be best coded, from the information we have, as a V-code. I think someone mentioned that they would not apply a v-code to "stable hypertension" but that arguement does not apply to this situation, as it is not stable hypoglycemia we are talking about, just as it is not stable elevated blood pressure reading. Also, when I said that I thought it would be better to assign a V-code, I didn't mean a History V-code. I meant a Follow-up V-code, as the doctor was following up on the, now stable, low blood sugar readings. I should have been more specific.

    It definitely would have been nice if the original poster had added more input. Like I said before, there very well could have been more information in the note that does point to Hypoglycemia. What little info we got did not and, as it currently stands, we may never know! BOOOO!
    Vanessa Mier, CPC

  2. Default
    The insertion of the word "STABLE'' by the Physician, in his documentation does really give significance in the patients status of being normal for him at this juncture/encounter.
    The follow up code could have a better place depending upon the encounter.

    But as regards the code from 251.x or 790 series, i think we could ponder a little more
    (having gone so far in this scenario)!! O.K?. Then , here we go:

    Stable hypo blood sugar or bold sugar hypolevel but stable; Isin't yet another way of placing it too?
    Physicians at some point or as a research, while treating diabetic patients for intensive diabetes management, at times, have a need to know whether the patient's glycemic level is stable (without risk or not with much significance) or at risk of detrimental condition.
    In such study, they want to know whether significant reduction in hypoglycemia was achieved (or not) without apparent deterioration of over all glycemia. Then after many tests/series of these hyposugar levels, they arrive at a status of hypo glucose level which is STABLE (after series of study) OR a status of Hypo glucose level which is detrimental or significant so much so that that status is not good for his health to keep going with that hypolevel.
    In the hypo and hyperlevels of glucose, take for eg, the hypolevel of glucose - that there is (a) a base level of blood hyop-gulucose which could be construded by the Physician as stable for that particular patient so that the treatment can be continued safelytill his next decision;
    (b) and there is detrimental or significant level of hypo sugar, which is not good to go on with and it is absolutely mandatory to reduce the treatment drug to a lower dose, so as to keep him/her in an optimal level or stable level.
    The Physician gets some time to watch over such patients who are stable and watch over with the same dose of management, and, intervene when it is appropriate to change the treatment dosage or modality.

    My point to present here is, in our coding component, I feel that this documentation, ‚ÄúStable‚ÄĚ hypo glucose /low sugar level is optimal or consistently tolerable /acceptable for this particular patient which keep him/her in stable condition and NOT a deseased condition, meaning it is not significant or detrimental to consider for an intervention with different treatment modality/dosage.
    A STABLE HYPOGLUCOSE LEVEL for this particular patient at this encounter- which is not a deseased/detrimental hyposugar level.
    So, I would not go for 251.2 which depicts an abnormal condition to be addressed with
    I would prefer yet 790.2 for abnormal glucose NOS. (though the 790.2 main category says to exclude hypoglycemia.) Could it be or not?
    Well, we do not consider this 251.2, as per our opinion, at all for our scenario, then we can very well think about the abnormal glucose NOS 790.2x, by all means, by eliminating the "exclusion" statement in 790.2 and boldly give 790.29
    It is only just a suggestion and for research not conclusive statement, regarding some situations of ‚Äėmedical Fix'like this‚Ķ . However, It is for your decision.
    Thank you for patiently listening.

  3. Default hypo blood sugars
    Respect both perspectives being exchanged and understand the passion in which you hold your viewpoints. Interestingly, in googling low blood sugar a few other points came to my attention. One source stated that blood sugar below 70mg/dl is considered low. Another link stated that the level of blood glucose low enough to define hypoglycemia may be different for different people, wow what a statement. This information would lend itself, to the physician using some discretion in this diagnosis. My personal thought is that the physician may not have been quite ready to commit to the diagnosis of hypoglycemia. It is clear that is appears that the physcian was monitoring the patient's blood work and maybe with time, based on the physician's experience or clinical knowledge of the condition, would tag the patient with the diagnosis of hypoglecemia. That is not a foreign word to physicians and to not use it, in this instance to me appears that he may not be quite ready to make the formal diagnosis of hypoglycemia. Personally speaking, I would query the physician to confirm with him this very coding dilemma ,because in his mind, it could be that he may have some clinical reason for not linking the patient to hypoglycemia, such as the link implied above, everyone is different or he may say, same thing, I just did not note it that way. I really do see the difficulty but I am of the opinion that sometimes the coding books do not always take us exactly where we need to go under certain given situations and that is where clinical knowledge, research and querying the physicians is very helpful but it is a guide and framework for us to work within. Just another opinion.....

  4. #34
    Hartford, CT
    This has been a very interesting discussion, but I agree with ballekll, i would query the physician. Actually when I read the first post I wondered why someone would post this and not ask the physician what he/she meant. While these forums are really great sometimes it's best to go right to the source and find out what the doc was thinking when he wrote this. this leads to a better understanding of their thought process and in the end makes our jobs easier. It also fosters better communication between the coder and the physician and can be used as a teaching tool. Many physicians don't understand the nuances in ICD and use terms interchangeably (I had one orthopedist who always coded rotator cuff tear as impingement syndrome until we discussed the meaning according to ICD). If i have something ambiguous like this I take the ICD book to the doctor and we look up the codes together, this helps them understand what I go through and how I assign codes based on their documentation. With ICD-10 on the horizon helping the docs become more specific in their documentation can only be a good thing.

  5. Default
    I greatly appreciate both your point of view, Ballekll and dclark7 which kindle my thought process once again as it often does to me who stand as ‚Äėboth the persons in one head'- a coder and a provider stand point of view. I agree in some places, it is hard to overcome the dilemma in coding when the clinical knowledge sets in!
    Yes, indeed , as dclark7 suggested an open minded healthy analytical conversation (between physician and coder ) will greatly help the coder, physician, the Healthcare revenue and the quality with a smooth sailing.
    Thank you for your insight.

  6. #36
    Stuart, Florida
    Not all coders have the opportunity to be able to ask the doctor. We don't all work right there, along side the physicians and other clinical staff. I'm pretty sure that everyone that answered this thread suggested speaking to the physician. It just isn't possible for everyone though. These forums allow us to figure things out and bounce ideas off eachother. Going straight to the source is a great idea but it's not always feasible which is why, although we may recommend trying to speak to the doctor IF it's possible, those of us that use the forums to ask and answer questions try our best to put our heads together and figure out what needs figuring out. Let's not even go into the doctors that cannot be bothered with questions... because they are out there too. I've got one physician that I can pretty much go to anytime. I have another that I pretty much have to schedule an appointment with just to speak to him about any concerns that I have. Coding isn't all lollipops, rainbows and butterflies! Lol.
    Vanessa Mier, CPC

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