Medical Coding of Diabetic Ketoacidosis

Diabetic Ketoacidosis– Symptoms, Diagnosis and ICD-10 Codes

Diabetes ketoacidosis occurs when your blood sugar is high and ketones build up in your body. Read about its symptoms, diagnosis and ICD-10 codes.

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Regarded as a life-threatening complication of diabetes, diabetes ketoacidosis (DKA) occurs when your body produces high levels of ketones. The condition develops when your body does not have enough insulin to process high levels of glucose in the blood. Insulin plays a major role in regulatingthe sugar (glucose - a major source of energy for your muscles and other tissues) entering your cells. Without adequate insulin, your body begins to break down fat as fuel called ketones, which causes the blood to become acidic. Ketones are normally produced when the body breaks down fat after a long time between meals. When ketones are produced too quickly and build up in the blood and urine, they can be toxic by making the blood acidic and leading to a condition called ketoacidosis. If left untreated, this condition can lead to serious complications like loss of consciousness, coma or even death. Physicians treating this diabetes-related disorder need to educate patients about the risks of this condition and prevent it by identifying the warning signs early and checking the urine and blood sugar level early. Endocrinologists and other diabetes specialists can rely on professional medical billing services to meet their medical coding and claim submission requirements.

According to the Centers for Disease Control and Prevention (CDC), diabetic ketoacidosis (DKA) affects approximately 30 million persons in the United States. The rate of DKA hospitalizations increased a total of 54.9%, (from 19.5 to 30.2% hospitalizations) per 1,000 people with diabetes (from 2009-2014). Each year (between 2009 and 2014) there was more than 6% rise in DKA hospitalizations annually across all age groups, with the highest rates among people under 45 years old. High levels of ketones can poison your body and is a warning sign that your diabetes is too high and is getting out of control. DKA most commonly affects people with Type 1 diabetes, but can at times also occur in people with Type 2 diabetes. The condition is usually triggered by prolonged uncontrolled blood sugar, missing doses of medicines, a severe illness or infection and a problem with insulin therapy. Other possible triggers include physical or emotional trauma, heart attack, alcohol or drug abuse and use of certain medications, such as corticosteroids and some diuretics.

Symptoms Generally, DKA signs and symptoms often develop quickly, sometimes within 24 hours. For some people, these symptoms may be the initial indication of having chronic diabetes. Other related symptoms include –

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Excessive thirst

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Weakness or fatigue

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Shortness of breath

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Nausea and vomiting

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High levels of ketones in the urine

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High blood sugar levels

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Fruity-scented breath

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Frequent urination

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Dry mouth and skin

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Confusion

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Abdominal pain

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A flushed face

How is DKA Diagnosed and Treated?

If your physician suspects diabetic ketoacidosis (DKA), he/she may conduct a physical examination along with blood tests to diagnose the condition. In some cases, additional tests may be recommended to determine which potential causes or risk factors triggered DKA. One of the first steps for diagnosis is related to testing for ketones in a sample of urine. Blood tests used in the diagnosis of DKA will measure – blood sugar level, ketone level and blood acidity. Other additional tests include - basic blood electrolyte, arterial blood gas (where blood is drawn from an artery to determine its acidity), blood pressure, urinalysis, routine chest X-ray, electrocardiogram and other tests to check for signs of an infection.

Treatment modalities for DKA generally comprise a combination of approaches to normalize blood sugar and insulin levels. People who get diagnosed with DKA but have not yet been diagnosed with diabetes will be treated with a clear plan for diabetes prevention to keep ketoacidosis from recurring. On the other hand, if the ketoacidosis is a result of an infection or illness, your doctor will treat that as well, usually with antibiotics. Common treatment options include – fluid replacement, insulin therapy and electrolyte replacement.

Diabetes screening is provided as preventive care service under the Affordable Care Act. Endocrinology medical coding involves the use of specific ICD-10 codes to document any such

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conditions, including diabetic ketoacidosis (DKA). ICD-10-CM codes used to indicate a diagnosis of DKA include – 

E10 - Type 1 diabetes mellitus 

E10.1 - Type 1 diabetes mellitus with ketoacidosis  E10.10 - Type 1 diabetes mellitus with ketoacidosis, without coma  E10.11 - Type 1 diabetes mellitus with ketoacidosis, with coma

As diabetes is a lifelong condition, incorporating healthy lifestyle changes can help slow or even stop the progression of the condition. Proper management of your blood sugar level is one of the best ways to prevent diabetic ketoacidosis (DKA). Other additional steps to prevent the occurrence of DKA include – consuming diabetes medication regularly (as prescribed by the physician), monitoring your blood sugar level at frequent intervals, adjusting your insulin dosage as needed, checking your ketone levels, following a healthy meal plan and staying hydrated with water.

Documenting diabetic ketoacidosis (DKA) for medical claims requires complete knowledge about the recent updates in medical billing and coding policies. Medical billing services provided by an experienced medical billing company can help physicians with timely claims processing that is crucial for revenue management.

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