# need help with diagnosis - Is there a diagnosis for stable



## ggparker14 (Feb 16, 2011)

Is there a diagnosis for stable hypo blood sugars?

Any help is appreciated.


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## nkawtgn (Feb 16, 2011)

I would just use the 251.2


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## mitchellde (Feb 16, 2011)

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.


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## terribrown (Feb 16, 2011)

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.


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## mitchellde (Feb 17, 2011)

terribrown said:


> 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.


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## terribrown (Feb 17, 2011)

mitchellde said:


> 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.


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## mitchellde (Feb 17, 2011)

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.


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## terribrown (Feb 17, 2011)

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.


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## mitchellde (Feb 17, 2011)

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!


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## terribrown (Feb 17, 2011)

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.


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## terribrown (Feb 17, 2011)

Just to be thorough, I went back to med terms 101 and come up with this explanation:
hypo: deficient, below, under, less than normal
glycemia: the presence of glucose in the blood
glucose: an optically active sugar 

When put together we have hypoglycemia is the deficient/less than normal amount of sugar in the blood. 

My final statement on this issue (because of less-entertaining work that I have to do): when the physician in the initial post stated "stable hypo blood sugar" he/she was referring to the current status of having low blood sugar (hypoglycemia) that is stable (not changing or fluctuating) and would require the 251.2 unspecified code and not a Vcode.


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## mitchellde (Feb 17, 2011)

Low blood sugar is not a definition of hypoglycemia, it must be abnormally low for one thing.  You as the coder are not allowed to make the determination that the blood sugar result is abnormally low.  For the provider to remark that the blood surgar was low is not the same thing as the provider stating the patient has hypoglycemia.  There are many other factors the provider considers as well, other symptoms such as faintness, confusion, headache, diaphoresis and so on.  The provider goes thru testing then to determine cause and diagnosis.  In this case the treatment provide stabilized the blood sugar and all is well, but the statement provided did not say the dx was hypoglcemia.  You can say that all persons with hypoglcemia have low blood sugar but not that all persons with low blood sugar have hypoglycemia. 
BTW Medical text book definition of hypoglycemia is an abnormally low blood sugar accompanied by symptoms that may incude faintness, tremors, nervousness, diaphoresis, motor weakness, palsy, ataxia, maked personality changes, etc.


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## terribrown (Feb 18, 2011)

The initial post did not include any of the signs or symptoms you are referring to under the definition of hypoglycemia. Does the patient in question suffer from these? We were not told. And even if we are told the s/s, when a diagnosis is made, we cannot code the s/s anyway. Hypo blood sugar is a valid, allowable diagnosis. This determine can only be made by an examination of blood. 

Your initial comment in this thread was that sometimes a condition found in the index maps us to the wrong code in the tabular. My disagreement with that is what started this whole thing. Once a condition is found in the index, absolutely we are to look in the tabular to make sure we have the correct code to the highest specificity. As you know, sometimes are are guided to a 4th- or 5th- digit...sometimes to a "code underlying condition first" guideline...sometimes to a "code additional manifestation if known" guideline. I do not pretend to know what the physician who wrote "stable hypo blood sugar" meant to say...I only know what he did say. You are the one who initiated the comment that "this sounds like a follow-up encounter" so a Vcode could be used. Even that information was not given to make that assumption. In the definitions I cited from the Merriam-Webster's Medical Dictionary (revised edition, 2005), the definition of hypoglycemia was "an abnormal decrease of sugar in the blood". A pathophysiology textbook that I consulted states that "hypoglycemia is defined as a fasting glucose level  less than 70 mg/dl. What does the textbook do for me with this question? Nothing. I was not given the lab report. So...we are not told the nature of the encounter, the s/s related to the diagnosis, nor the lab report to view the glucose levels.

All I know from the question asked was how to code "stable hypo blood sugar". My response to use code 251.2 is backed up with coding guidelines. For whatever reason the experts who put this whole system together guides us to use the same code for "low blood sugar" as we do for "hypoglycemia". The word "stable" means nothing from the coding perspective in relation to this diagnosis.  When the physician is evaluating the status (yes, even stable) of a condition THAT IS STILL PRESENT but not changing/fluctuationg, we are to code as a current diagnosis.

Debra, I respectfully ask that you post exactly what code you would use. You gave a range of suggestions and arguments against a code, but nothing concrete with the rationale as to the exact code that you would use. I thrive on learning new things and if I am wrong on how to code stable hypo blood sugar, I welcome the correction.


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## terribrown (Feb 18, 2011)

mitchellde said:


> Low blood sugar is not a definition of hypoglycemia, it must be abnormally low for one thing.  You as the coder are not allowed to make the determination that the blood sugar result is abnormally low.  For the provider to remark that the blood surgar was low is not the same thing as the provider stating the patient has hypoglycemia.  There are many other factors the provider considers as well, other symptoms such as faintness, confusion, headache, diaphoresis and so on.  The provider goes thru testing then to determine cause and diagnosis.  In this case the treatment provide stabilized the blood sugar and all is well, but the statement provided did not say the dx was hypoglcemia.  You can say that all persons with hypoglcemia have low blood sugar but not that all persons with low blood sugar have hypoglycemia.
> BTW Medical text book definition of hypoglycemia is an abnormally low blood sugar accompanied by symptoms that may incude faintness, tremors, nervousness, diaphoresis, motor weakness, palsy, ataxia, maked personality changes, etc.



You are so adament that we are not to believe that the low blood sugar code is the same as the hypoglycemia code as stated in our coding book, yet you assume that "In this case the treatment provide[d] stabilized the blood sugar and all is well". Where do you get that?? What treatment? Is all well?? If this were the case, why didn't the physician write "normal blood sugars"? I am not ASSUMING what the s/s are. I am not ASSUMING that treatment was administered. I am not ASSUMING all is well. I am CODING "stable hypo blood sugar" as written.

What code would you assign to the diagnosis of "hypo blood sugar"?


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## eadun2000 (Feb 18, 2011)

Okay, my two cents for what they are worth.  The CORRECT code is 251.2.  Period, cut and dry.  Something to think about.  I have a rare autoimmune disease called "Behcet's disease or Behcet's Syndrome".. whatever you want to call it.  In the ICD-9 book it has it listed under other and unspecified infectious and parasitic disease.  I can tell you that it not infectious nor parasitic.... it is AUTOIMMUNE... same as lupus, rheumatoid arthritis, etc.  Just because it is placed under the unspecified infectious and parasitic diseases in the book, does not MEAN it is an infectious and parasitic disease.  Why they have it there, I do not know... maybe because it is so rare??? with only 15,000 Americans having it and they didn't know where else to put it?  Who knows.  All we can do is follow the correct path to the code.  Just because the code is in a place that it should not be does not make it an incorrect code, same as if the code can have a different meaning... still the same code.  Period.


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## mitchellde (Feb 18, 2011)

First I do not assume anything, I suggested a followup code as opposed to assigning a dx not documented.  I honestly feel there is not enough information to assign a diagnosis and I would query the physician for more information.  It is possible the original poster has more information and has not posted it.  I was not suggesting we make any determination given signs and symptoms, I only listed that to show there is more to a diagnosis of hypoglycemia than a low blood sugar result.  The definition states the result must be abnormally low and we have no way of knowing if a statement of hypo blood sugar is abnormally low or just low.  What I am saying is we cannot assign a diagnosis not rendered.  The 251.2 code is not a code for a low blood sugar reading it is a code for a diagnosis of hypoglycemia and they are are not interchangeable terms.  The chapter title as well as the category heading do have meaning and must be adheared to... I do understand why Behcets disease is located in the infectious and parasitic diseases chapter, and it is in the correct place.  
ICD codes are created by the CDC, by a physicians and specialists that study diseases and disease processes the book is their design.  We cannot change the definition or placement of a code.  
I am sorry to disagree with everyone but speaking from the experience of having been given a diagnosis of hypoglycemia when it was not documented and anemia when it was not documented, I am saying if it is not documented we cannot code it.  What we were given was stable hypo blood sugar and that is not the same thing as 251.2.  Perhaps more information is what is called for.


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## eadun2000 (Feb 18, 2011)

removed because you are not worth my time nor energy.


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## eadun2000 (Feb 18, 2011)

mitchellde said:


> First I do not assume anything, I suggested a followup code as opposed to assigning a dx not documented.  I honestly feel there is not enough information to assign a diagnosis and I would query the physician for more information.  It is possible the original poster has more information and has not posted it.  I was not suggesting we make any determination given signs and symptoms, I only listed that to show there is more to a diagnosis of hypoglycemia than a low blood sugar result.  The definition states the result must be abnormally low and we have no way of knowing if a statement of hypo blood sugar is abnormally low or just low.  What I am saying is we cannot assign a diagnosis not rendered.  The 251.2 code is not a code for a low blood sugar reading it is a code for a diagnosis of hypoglycemia and they are are not interchangeable terms.  The chapter title as well as the category heading do have meaning and must be adheared to... I do understand why Behcets disease is located in the infectious and parasitic diseases chapter, and it is in the correct place.
> ICD codes are created by the CDC, by a physicians and specialists that study diseases and disease processes the book is their design.  We cannot change the definition or placement of a code.
> I am sorry to disagree with everyone but speaking from the experience of having been given a diagnosis of hypoglycemia when it was not documented and anemia when it was not documented, I am saying if it is not documented we cannot code it.  What we were given was stable hypo blood sugar and that is not the same thing as 251.2.  Perhaps more information is what is called for.



Let me state this for the record... according to 3M, AS WELL AS ICD-9  hypo blood sugar IS coded to 251.2.


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## ohn0disaster (Feb 21, 2011)

This may be a little late, but I wanted to add my input to this discussion. 

The initial post asks for a diagnosis code for "stable hypo blood sugars" and includes no other information/documentation. That being said, I agree with Debra. Unless there is more information included in the note that we do not have, the doctor is not giving a diagnosis of hypoglycemia. Let me explain why...

In those treated for diabetes, a diagnosis of hypoglycemia can be made based on the presence of a low blood sugar alone. Otherwise, Whipple's triad is required which include symptoms consistent with hypoglycemia, a low blood sugar, and resolution of these symptoms once the blood sugar improves.

Unless this patient is a diabetic, we cannot assign code 251.2 from the stated documentation alone.

Also, you arrived at the conclusion of hypoglycemia by looking through the index, starting at sugar. However, if you go to the index listing under *Decrease, decreased* (aka hypo) and look down at *glucose*, it gives you the code 790.29. Upon viewing the Tabular List, you can see that this code is listed as *Other abnormal glucose*. This code is also the code used for a patient with elevated glucose, in which no formal diagnosis of Diabetes is given. In this case, it is low glucose in which no formal diagnosis of Hypoglycemia was given.

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.


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## eadun2000 (Feb 21, 2011)

ohn0disaster said:


> This may be a little late, but I wanted to add my input to this discussion.
> 
> The initial post asks for a diagnosis code for "stable hypo blood sugars" and includes no other information/documentation. That being said, I agree with Debra. Unless there is more information included in the note that we do not have, the doctor is not giving a diagnosis of hypoglycemia. Let me explain why...
> 
> ...



My two cents again... hypo does not mean decrease or decreased... hypo prefix means low, under, beneath, down or below normal.  No where does hypo definition state decrease or decreased.  Based on the only documentation that we have available, which is stable hypo blood sugars, it is 251.2.


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## ohn0disaster (Feb 21, 2011)

eadun2000 said:


> My two cents again... hypo does not mean decrease or decreased... hypo prefix means low, under, beneath, down or below normal.  No where does hypo definition state decrease or decreased.  Based on the only documentation that we have available, which is stable hypo blood sugars, it is 251.2.



There are many synonyms for "hypo" including, but not limited to those that you have listed. For instance, per Stedman's Medical Dictionary, hypo- is defined as "Prefix denoting deficient, below normal". Decreased is, in fact, synonymous with hypo.

Regardless of if you agree with that or not does not change the fact that Hypoglycemia, again defined per Stedman's Medical Dictionary, is "Symptoms resulting from low blood glucose (normal glucose range 60-100 mg/dL [3.3-5.6 mmol/L]), which are either autonomic or neuroglycopenic. Autonomic symptoms include sweating, trembling, feelings of warmth, anxiety and nausea. Neuroglycopenic symptoms include feelings of dizziness, confusion, tiredness, difficulty speaking, headache, and inability to concentrate."

So, how exactly do you get that out of "stable hypo blood sugars"? You don't. I also urge you to look up "Whipple Triad".



> The signs and symptoms of hypoglycemia may not always be evident at specific blood glucose levels. Individual variations may explain why some patients show symptoms at blood glucose levels that would be considered low but normal. However, in order for hypoglycemia to be conclusively be diagnosed, it should meet with the three criteria as outlined in Whipple's triad.
> 
> These three criteria help to identify borderline hypoglycemia :
> 
> ...



Again, I believe that if there is not already more documentation provided in the note, you should query the physician.


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## ohn0disaster (Feb 21, 2011)

PS
I'm, in no way, trying to get involved in a pissing contest of any sorts. I did not add my input to be rude, anger, or upset anyone. I firmly believe that this forum is a great assistance to all of us. There have been times where I have stated my input only to realize that I was previously misunderstanding and my point of view was wrong, plain and simple. The problem with forums like these is that many times, as we are all so passionate about our work, we are blind to the information being given because we believe we are right.

When it comes down to it, this patient could very well be Hypoglycemic. However, there is not enough documentation posted to know that. To so strongly insist that your answer is THE definitive answer, when others disagree, kind of defeats the purpose of this forum.


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## mitchellde (Feb 21, 2011)

I still fail to see how you correlate the statment "stable hypo blood sugar" to a diagnosis of hypoglycemia.  It just does not make sense.  The patient could be a diabetic that has been having a series of low blood sugar readings that needed to have their insulin adjusted, It could have been a reaction to an drug the patient was on and now the sugars have stablized.  I am trying to convey the point that for a provider to make a remark about a low blood sugar ( which is all you have here)  is not the same as the provider rendering a diagnosis of hypoglycemia.


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## terribrown (Feb 28, 2011)

The comments from coders not wanting to use the 251.2 code have something in common. We are being warned not to give a diagnosis of hypoglycemia because that is not what the physician said. I did NOT assign 251.2 by assuming the physician meant hypoglycemia and therefore I looked up hypoglycemia in the index and confirmed in the tabular. I DID however, come to the 251.2 code by looking in the index for EXACTLY what the physician wrote. As in a previous example I showed that "itch" guides us to an unspecified pruritis code. Do all itches mean pruritis? No. But if itch is all we have, the coding experts guide us to the pruritis category. Their reasoning...not mine.

While it is the agreement that we cannot assume what the physician meant, it is my practice not to assume what he did not mean either. Stable is a descriptor for the physician's management of  a condition. I would never argue that when a physician writes "hypertension-stable" he really means the patient is cured and assign a Vcode. Stable/unstable, controlled/uncontrolled are words describing a current condition that still needs monitored.


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## ohn0disaster (Feb 28, 2011)

I want to point out that, though I DID in fact point out that we are not to assume what the physician _means_ by what they are documenting rather we are to code exactly what is stated, that was not my only arguement. I also want to point out that, though the Index is there to guide us, we are NOT to code from the index. Starting from the time that I was studying to be a CPC in school, that is what I have ALWAYS been told.

The dx is stable hypo (aka low) blood sugars, not hypoglycemia. There is more to Hypoglycemia than having low blood sugar readings. I posted that information already. If there is more to the documentation that points to Hypoglycemia, the orginal poster has not posted it.


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## mitchellde (Feb 28, 2011)

Thank You Vanessa!  While the index will lead you to the 251 code for the low blood sugar, as a coder you then need to determine if this is in fact the code you were looking for.  The chapert the code is in, is it correct?, the category heading you find you code in does it apply?  And in this case to code the patient as have an endorcrine disorder is not for us to say, there is not enough documenation.  For instance, the patient is on anticoagulants and the index leads you to 964.2 which says anticoagulant, would you then use this code?  or would you look to see that you are in the chapter for injury and poisoning, and a catergory for poisoning by agent.  I think you would try a different search word!  Alos a patient is fine and comes to the provider due to missed periods and a suspicion that they are preganant.  would you look up missed periods or amenorrhea and get 626.0 and code that?   Or would you look and see that you are in the chapter for diseases of the genitourinart system and a catergory for Disorders of menstruation and other abnormal bleeding from female genital tract, when the only thing is the patient has missed a couple of periods and thinks she is pregnant?  you need to look for a different code as the chapter and the category are wrong for your scenario.  Yes the index assists us with looking up codes but it is not infallible in where it takes us.  We must use our skill and education as a coder to discern if the code found is the correct code for the documentation provided.  So look at what is documented again and see what is being communicated.  The diagnosis is the PATIENT'S and we have a duty and responsibility to be 100% CORRECT at all times!


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## eadun2000 (Feb 28, 2011)

I just say we can all agree to disagree on this one.  Everybody has valid points and I can see where they are coming from.  HOWEVER, I personally still stand by my code.. 251.2.  I understand you do not agree and that is okay.  That is just how I see it.


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## jdibble (Mar 1, 2011)

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!


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## eadun2000 (Mar 1, 2011)

jdibble said:


> 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!



Glad you joined the discussion!  I don't think (again my opinion) that  you can use a V code in this situation because he states it it stable.  Stable does not mean no longer being treated.  Just like you can have stable hypertension.. you still have hypertension... not a history of.  If it was no longer being treated then he would have said resolved, not stable.  Again, just my opinion


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## jdibble (Mar 1, 2011)

eadun2000 said:


> Glad you joined the discussion!  I don't think (again my opinion) that  you can use a V code in this situation because he states it it stable.  Stable does not mean no longer being treated.  Just like you can have stable hypertension.. you still have hypertension... not a history of.  If it was no longer being treated then he would have said resolved, not stable.  Again, just my opinion



That's true - stable is not gone.  Then I would have coded the 790.29 - from the symptom section.  Of course that is my opinion!   I just feel that a little more info from the original poster should have been provided...they have not commented on this thread at all!!!  I wonder what they ended up using?


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## ohn0disaster (Mar 1, 2011)

ohn0disaster said:


> 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.





jdibble said:


> 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!


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## preserene (Mar 1, 2011)

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, t*hey 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 safely*till 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, “Stable” 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 ‘medical Fix'like this… .   However, It is for your  decision.
Thank you for patiently listening.


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## ballekll (Mar 15, 2011)

*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.....


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## dclark7 (Mar 16, 2011)

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.


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## preserene (Mar 19, 2011)

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 ‘both 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.


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## ohn0disaster (Mar 21, 2011)

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.


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