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need help with diagnosis - Is there a diagnosis for stable

  1. #1
    Default need help with diagnosis - Is there a diagnosis for stable
    Medical Coding Books
    Is there a diagnosis for stable hypo blood sugars?

    Any help is appreciated.

  2. #2
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    I would just use the 251.2

  3. #3
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    You cannot give the patient the dx of hypoglycemia as it is not what the physician has stated. This looks like a followup encounter so possibly a V67.xx code for followup following tx. It is hard to tell without the documentation.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
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    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.

  5. #5
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    Quote Originally Posted by terribrown View Post
    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.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
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    Quote Originally Posted by mitchellde View Post
    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.
    I disagree with your general statement that the index does not necessarily guide us to the correct code. In your example, the index for Low, Hemoglobin guides us to code 285.9. In the tabular 285.9 states Anemia, unspecified. According to Merriman-Webster's Medical Dictionary (Revised edition 2005), the definition of anemia is:
    a condition in which the blood is deficient in red blood cells, in hemoglobin, or in total volume
    Therefore, it is correct that unspecified anemia is a condition of blood with deficient (low/hypo) hemoglobin and the 285.9 code would be used.

    Your understanding that not all conditions of "hypo" or "hyper", "low" or "deficient" will guide to another condition's code is correct such as elevated (or high) blood pressure would not map from index to tabular to the same code as hypertension. But when the index does guide us, it is correct to use it.

    I stand by my first posting in which I said that when a physician states "stable", he/she is addressing the status of a CURRENT condition and should be coded as such. If he/she states "resolved", there is no evidence of that condition being present and therefore a Vcode is applicable. It is important to note that hypo blood sugar mapped us to hypoglycemia NOT diabetes.
    Last edited by terribrown; 02-17-2011 at 09:21 AM.

  7. #7
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    I wish I could agree with you but I do not. We are not allowed to interpret we can code from what is documented. The alpha will guide us to a code, yes.... however it is our responsibility then to ascetain whether or not that is in fact what has been documented. We cannot determine if a low or hypo blood sugar means the patient is hypoglycemic. I have had a low blood sugar reading but I was not hypoglycemic. I have had low hemoglobin readings but I do not have anemia. If the provider intended the patient to have a clinical diagnosis of hypoglycemia or anemia he would hav e stated so. He is making a statement that the patients blood sugars are now stable. Perhaps he was sitting on the fence of a hypoglycemic diagnosis but now feels that is inappropriate. It is not our call to make. Sorry I disagree. As far as the Medical dictionary definition of anemia goes, it is correct for a clinical dx of anemia, however for the provider to say the hemoglobin is low is not then for us to make the leap to the definition that this indicates an overall deficiency of red blood cells, it is an isloated reading.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
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    Wow Debra...I wish we were colleagues to discuss many issues. I would love to pick your brain.

    I do agree that we are not interpret a diagnosis...we must code what is documented. Where we differ is in definitions I believe.

    Unspecified anemia is not ONLY dealing with low red blood cells...it can mean be low hemoglobin...or low total volume. That is why it is an unspecified (default) code. The physician did not document specifically the TYPE or CAUSE of anemia, but he did want to specify what was deficient in the blood...in this case hemoglobin.

    As far as low blood sugar and hypoglycemia...the definition of hypoglycemia from the same dictionary quoted before is: abnormal decrease of sugar in the blood. The physician may not know the cause of the decrease to definitively diagnose as diabetes for example, but he is evaluating the levels to make a determination of the stability. Hypoglycemia is the state of having low blood sugar levels. Hypoglycemic means something is happening because (caused by/affected) of the low blood sugar. Two different things. One can have hypoglycemia without being hypoglycemic. According to this example, "stable low blood sugars" is the evaluation of the stability (or maintaining levels) of blood sugars that are STILL deficient but not severe enough to be causing a manifestion for a more definitive diagnosis. If he was stating the blood sugars were stable...why did he include "hypo"? Because of this inclusion, I must not ignore it and should continue to code as a current status of low blood sugar that guides me to the 251.2.
    Last edited by terribrown; 02-17-2011 at 10:08 AM.

  9. #9
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    I agre you can have a low blood sugar and not be hypoglyemic which is why you cannot code the 251 code that is a diagnosis of hypogycemia not a finding of low blood sugar. just as the 285.9 is a diagnosis of anemia not a finding of a low hemoglobin signs and symptom codes are in the cahpter for signs and symptoms you are using codes from specific deseases and disorders categories. We must be careful that we do not render a diagnosis the patient does not posess. As I said I do not have anemia but I occasionally have a low hemoglobin.
    Yes it would be fun to discuss these types of things with someone whose eyes do not glaze over just when it gets good!

    Debra A. Mitchell, MSPH, CPC-H

  10. Default
    I think we are at an empasse and I welcome an opinion from someone who could mediate. (wink)

    When a diagnosis is documented as stable hypo low blood sugar, I do not consider this a sign or symptom for a code from category 780-799 or just a finding that requires a Vcode. This is a diagnosis in its own right...and our coding books guides us to such. There are many conditions in which your reasoning is right on...such as chronic cough would not be found in the index that guides us to bronchitis...chest pain in the index would not guide us to angina in the tabular.

    When we find a code in the index that cross-references us to a different name in the tabular doesn't mean it is wrong. It means it is an inclusive definition. According to our code book, a diagnosis of hypo blood sugar USES THE SAME CODE as hypoglycemia. Another example of such...Itch in the index guides us to use 689.9 Unspecified pruritic condition under the Pruritis category. Even though the physician only diagnosed "itch" we are to USE THE SAME CODE as an unspecified pruritis condition.

    Again I say that the 251.2 that I would use for hypo blood sugar is also used for hypoglycemia UNSPECIFIED is correct. I am not coding a specified type of hypoglycemia or hypoglycemic condition. Another example: a diagnosis of elevated PSA in the index guides me to 790.93 in the 790 Nonspecific findings on examination of blood category NOT 600.00 for BPH. I use this example to show that if the 251.2 code for hypo blood sugars (obtained obviously through examination of blood) was not to be used because it is the same code used for unspecified hypoglycemia (which according to your explanation they are not interchangable) why are we not guided to a code from the 790 category or more specifically a 790.9x code?

    We are to be meticulous to determine the best suitable code for the diagnosis documented. In the case of the hypo blood sugar...I trust that our code book guides us the best suitable code for this unspecific diagnosis.
    Last edited by terribrown; 02-17-2011 at 10:45 AM.

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