# Elecated A1C



## cjswanson (Apr 4, 2013)

I'm new to coding and was needing help. I'm not what code to use for elevated A1c? Also, do I use 272.2 (they have a past diagnosis of mixed hyperlipidemia) for hypertriglycerdemia? Thanks for you help!


----------



## vj_tiwari (Apr 10, 2013)

Hey 

1. From Wikipedia I found this for you, Glycated hemoglobin or glycosylated hemoglobin (hemoglobin A1c, HbA1c, A1C, or Hb1c; sometimes also HbA1c) is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods of time. It is formed in a non-enzymatic glycation pathway by hemoglobin's exposure to plasma glucose. Normal levels of glucose produce a normal amount of glycated hemoglobin. As the average amount of plasma glucose increases, the fraction of glycated hemoglobin increases in a predictable way. This serves as a marker for average blood glucose levels over the previous months prior to the measurement.

In diabetes mellitus, higher amounts of glycated hemoglobin, indicating poorer control of blood glucose levels, have been associated with cardiovascular disease, nephropathy, and retinopathy. Monitoring HbA1c in type 1 diabetic patients may improve outcomes.

But here' a twist... As per ICD 9 CM, Disease of Index, Findings, (abnormal), without diagnosis (examination) (laboratory test) => hemoglobin => Elevated => 282.7.

282.7: Other hemoglobinopathies
Abnormal hemoglobin NOS
Congenital Heinz-body anemia
Disease:
hemoglobin C [Hb-C]
hemoglobin D [Hb-D]
hemoglobin E [Hb-E]
hemoglobin Zurich [Hb-Zurich]
Hemoglobinopathy NOS
Hereditary persistence of fetal hemoglobin [HPFH]
Unstable hemoglobin hemolytic disease

But Hemoglobinopathy is a kind of genetic defect that results in abnormal structure of one of the globin chains of the hemoglobin molecule. Hemoglobinopathies are inherited single-gene disorders; in most cases, they are inherited as autosomal co-dominant traits. Common hemoglobinopathies include sickle-cell disease. It is estimated that 7% of world's population (420 million) are carriers, with 60% of total and 70% pathological being in Africa. Hemoglobinopathies are most common in ethnic populations from Africa, the Mediterranean basin and Southeast Asia.

Hemoglobinopathies imply structural abnormalities in the globin proteins themselves. Thalassemias, in contrast, usually result in underproduction of normal globin proteins, often through mutations in regulatory genes. The two conditions may overlap, however, since some conditions which cause abnormalities in globin proteins (hemoglobinopathy) also affect their production (thalassemia). Thus, some hemoglobinopathies are also thalassemias, but most are not.

So I think, for elevated A1c rather coding 282.7 (Blood disease) we can go with 790.99 (Other nonspecific findings on examination of blood). 

2. If Patient is diagnosed with hypertriglycerdemia then we can only use 272.1 (Please refer Tabular list of ICD 9CM for the same).

Hope this helps!!!

VJ


----------



## dha_coder (Apr 10, 2013)

Hi VJ,

HbA1C in elevated condition, this is the right approch. I am also suggest 790.99.


----------



## bsesender (Oct 23, 2015)

*elevated hemoglobin a1c*

to be more specific i would suggest 790.29 other abnormal glucose; as a1c is a measure of glucose over a period of time and you indicated it was elevated.


----------

