EmailStarvation ketosis
Publication Date: September 2018
ICD 10 AM Edition: Tenth edition
Query Number: 3026
34/40 pregnant lady with pre-existing type 1 diabetes admitted with 2 week history of nausea and vomiting and unstable blood sugars. She was positive for blood ketones but not acidotic. Insulin was adjusted and IV dextrose given and patient stabilised.
Discharge diagnosis was "Starvation ketosis" (not ketoacidosis).
What is the correct way to code this?
O24.0 Pre-existing diabetes mellitus, Type 1, in pregnancy does not alone adequately describe the condition.
E10.11 Type 1 diabetes mellitus with ketoacidosis, without coma seems to be incorrect as patient did not have acidosis and as the patient is pregnant, O24.0 seems more accurate
E88.8 Other specified metabolic disorders if "diabetic", the Index directs to see Diabetes with ketoacidosis. Documentation does not refer to "diabetic ketosis", rather "diabetes with starvation ketosis"
Do I need a code for starvation T73.0 Effects of hunger?
Discharge diagnosis was "Starvation ketosis" (not ketoacidosis).
What is the correct way to code this?
O24.0 Pre-existing diabetes mellitus, Type 1, in pregnancy does not alone adequately describe the condition.
E10.11 Type 1 diabetes mellitus with ketoacidosis, without coma seems to be incorrect as patient did not have acidosis and as the patient is pregnant, O24.0 seems more accurate
E88.8 Other specified metabolic disorders if "diabetic", the Index directs to see Diabetes with ketoacidosis. Documentation does not refer to "diabetic ketosis", rather "diabetes with starvation ketosis"
Do I need a code for starvation T73.0 Effects of hunger?
Response
This query was originally published in the 2015-16 June Database as follows:
VICC advises that the correct code to assign for starvation ketosis is E88.8 Other specified metabolic disorders which is the default code at Lead term Ketosis. As you have noted, the Index entry for 'diabetic' should not be followed because your documentation does not specify 'diabetic'. In this scenario, E88.8 is the principal diagnosis as it is documented as such on the discharge summary.
The term 'starvation' refers to the type of ketosis rather than a clinical diagnosis of starvation, therefore VICC does not support the assignment of a code for starvation.
With respect to the coding of the diabetes, VICC agrees that it is incorrect to assign E10.11 Type 1 diabetes mellitus with ketoacidosis, without coma because the patient does not have ketoacidosis.
VICC referred the coding of O24.0 in this case to the ACCD who provided the following advice:
"When a pregnant patient is admitted with diabetes mellitus, assign an appropriate code from O24 Diabetes mellitus in pregnancy; there does not need to be documentation that the diabetes mellitus is complicating the pregnancy.
See ACS 0001 Principal diagnosis/Obstetrics for guidelines regarding sequencing in antepartum and delivery episodes.
The classification of complications of pregnancy is being reviewed for Tenth Edition".[end of original response]
VICC has updated the response (third paragraph) to clarify that E10.11 Type 1 diabetes mellitus with ketoacidosis, without coma is not assigned in this scenario because there is no documentation of diabetic ketosis. The updated response is below:
VICC advises that the correct code to assign for starvation ketosis is E88.8 Other specified metabolic disorders which is the default code at Lead term Ketosis. As you have noted, the Index entry for 'diabetic' should not be followed because your documentation does not specify 'diabetic'. In this scenario, E88.8 is the principal diagnosis as it is documented as such on the discharge summary.
The term 'starvation' refers to the type of ketosis rather than a clinical diagnosis of starvation, therefore VICC does not support the assignment of a code for starvation.
With respect to the coding of the diabetes, VICC agrees that it is incorrect to assign E10.11 Type 1 diabetes mellitus with ketoacidosis, without coma because there is no documentation of diabetic ketosis.
VICC referred the coding of O24.0 in this case to the ACCD who provided the following advice:
"When a pregnant patient is admitted with diabetes mellitus, assign an appropriate code from O24 Diabetes mellitus in pregnancy; there does not need to be documentation that the diabetes mellitus is complicating the pregnancy.
See ACS 0001 Principal diagnosis/Pregnancy, childbirth and the puerperium for guidelines regarding sequencing in antepartum and delivery episodes.
The classification of complications of pregnancy is being reviewed for Tenth Edition".
VICC advises that the correct code to assign for starvation ketosis is E88.8 Other specified metabolic disorders which is the default code at Lead term Ketosis. As you have noted, the Index entry for 'diabetic' should not be followed because your documentation does not specify 'diabetic'. In this scenario, E88.8 is the principal diagnosis as it is documented as such on the discharge summary.
The term 'starvation' refers to the type of ketosis rather than a clinical diagnosis of starvation, therefore VICC does not support the assignment of a code for starvation.
With respect to the coding of the diabetes, VICC agrees that it is incorrect to assign E10.11 Type 1 diabetes mellitus with ketoacidosis, without coma because the patient does not have ketoacidosis.
VICC referred the coding of O24.0 in this case to the ACCD who provided the following advice:
"When a pregnant patient is admitted with diabetes mellitus, assign an appropriate code from O24 Diabetes mellitus in pregnancy; there does not need to be documentation that the diabetes mellitus is complicating the pregnancy.
See ACS 0001 Principal diagnosis/Obstetrics for guidelines regarding sequencing in antepartum and delivery episodes.
The classification of complications of pregnancy is being reviewed for Tenth Edition".[end of original response]
VICC has updated the response (third paragraph) to clarify that E10.11 Type 1 diabetes mellitus with ketoacidosis, without coma is not assigned in this scenario because there is no documentation of diabetic ketosis. The updated response is below:
VICC advises that the correct code to assign for starvation ketosis is E88.8 Other specified metabolic disorders which is the default code at Lead term Ketosis. As you have noted, the Index entry for 'diabetic' should not be followed because your documentation does not specify 'diabetic'. In this scenario, E88.8 is the principal diagnosis as it is documented as such on the discharge summary.
The term 'starvation' refers to the type of ketosis rather than a clinical diagnosis of starvation, therefore VICC does not support the assignment of a code for starvation.
With respect to the coding of the diabetes, VICC agrees that it is incorrect to assign E10.11 Type 1 diabetes mellitus with ketoacidosis, without coma because there is no documentation of diabetic ketosis.
VICC referred the coding of O24.0 in this case to the ACCD who provided the following advice:
"When a pregnant patient is admitted with diabetes mellitus, assign an appropriate code from O24 Diabetes mellitus in pregnancy; there does not need to be documentation that the diabetes mellitus is complicating the pregnancy.
See ACS 0001 Principal diagnosis/Pregnancy, childbirth and the puerperium for guidelines regarding sequencing in antepartum and delivery episodes.
The classification of complications of pregnancy is being reviewed for Tenth Edition".
