Pediatric Coding Alert

Question: What is the proper way to bill for diabetic ketoacidosis?

Wisconsin Subscriber

Answer: Diabetic ketoacidosis (DKA) is a potentially fatal complication of diabetes. Because of the severity and potential complications of DKA, most of these patients will be managed in the emergency department (ED), observation unit or admitted to the hospital. Some will require intensive care. Except for the mildest presentation, most patients with DKA will require a minimum of 24 hours of supervised care.

DKA patients will usually meet the criteria for high-complexity medical decision-making: 99285 for ED services, and 99215 (established patient) for those initially managed in the office or clinic. Office/clinic care will usually also qualify for office emergency services, 99058. Critical patients requiring more than 30 minutes of physician care time should be billed with the critical care codes, 99291-99292. Additional physician services could include therapeutic IV therapy (90780-90781) and arterial puncture (36600), which are bundled in the critical care codes. The appropriate observation or inpatient codes should be used for admitted patients. These patients will usually require high-complexity medical decision-making, meeting the criteria for 99233 for the subsequent hospital day.

Use 250.13 for new onset diabetics and known Type I diabetics who present with DKA without coma, and 250.33 for patients with DKA and coma. Symptoms such as dehydration, nausea and vomiting, abdominal pain, or mental-status changes should not be coded separately because they are all inherent in DKA.


Answers to You Be the Coder and Reader Questions contributed by Richard H. Tuck, MD, FAAP, member of the American Academy of Pediatrics coding and reimbursement committee and a practicing pediatrician in Zanesville, Ohio; Jeffrey F. Linzer Sr., MD, FAAP, MICP, assistant professor of pediatrics at Emory University and director of emergency medicine at Childrens Healthcare of Atlanta; Thomas Kent, CMM, CPC, president of Kent Medical Management, a coding and practice management company in Dunkirk, Md; Mark S. Reuben, MD, FAAP, president of Reading Pediatrics, an eight-pediatrician practice in Wyomissing, Pa.; Victoria Jackson, chairwoman of the pediatric task force committee of the Medical Group Management Association and administrator/CEO of Southern Orange County Pediatric Associates in Lake Forest, Calif.; and Jennifer Nelson, CCS-P, office manager and independent coding consultant in Corinna, Maine.