Pediatric Coding Alert

Question: What is the correct diagnosis coding for a patient who has type 1 diabetes and lactic or metabolic acidosis? Would I use E10.10?

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Answer: In this situation, E10.10 (Type 1 diabetes mellitus with ketoacidosis without coma) is not the correct code to use because the patient’s diagnosis is for type 1 diabetes with lactic acidosis. This condition, which is also known as metabolic acidosis, is different from diabetic ketoacidosis (DKA).

DKA is one form of metabolic acidosis that is caused by a buildup of ketones, an acid that is produced when the body cannot supply enough glucose to the blood cells. The DKA is a direct result of the diabetes.

Lactic acidosis is another, different form of metabolic acidosis that is caused by a buildup of lactic acid, which occurs when oxygen levels are low due to vigorous exercise, in carbon monoxide poisoning, and in excessive alcohol use. So, diabetes does not cause lactic acidosis.

Because of that, you will need two codes for the patient to reflect that the two conditions are not related. You will use E87.2 (Acidosis) along with the appropriate code from E10.- (Type 1 diabetes mellitus), assuming this is, in fact, what your pediatrician documented.

Excludes1 reminder: The note accompanying E87.2 tells you not to code it with any of the diabetes mellitus with ketoacidosis (E08.1-, E10.1-, E11.0- or E13.1-) codes.