dehydration and hyponatremia

laura.bohls@prairielakes.comlaura.bohls@prairielakes.com
in CDI Talk Archive
Anyone have a query to get the physicians to say hyponatremia they would be willing to share? I frequently have our doctors say dehydration and they think that covers it all. I'm having trouble with the wording to not lead them. Thanks

Laura Bohls, RN CDS
Prairie Lakes Hospital

Comments

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    I would probably simply give the lab value and treatment and ask what was being treated.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • robert.hodges2robert.hodges2
    edited May 2016
    Wow, this is a challenge. I guess I would ask how dehydration would lead to hyponatremia, I would expect hypernatremia with dehydration. If the lab value is documented in their note, then you could ask for clinical significance of the finding and an associated diagnosis or cause of the finding.

    That's all I can think of.

    Robert

    Robert S. Hodges, BSN, MSN, RN, CCDS
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  • Unknown
    edited May 2016
    Please document the clinical significance, if any of the abnormal electrolytes (sodium = ___) in this patient with dehydration. (And list any other clinical indicators)

    (Choices I list:)

    - not clinically significant - hyponatremia - unable to determine - other more appropriate diagnosis

    Charlene
  • ajeffrey1ajeffrey1
    edited May 2016
    If dehydration is documented with hyponatremia, assign only a code for the
    hyponatremia (276.1). It is a integral part of a condition so avoid to
    place query based on only one insignificant lab value.

    Common causes of hyponatremia include the consumption of excessive water
    during exercise, diuretics, syndrome of inappropriate antidiuretic hormone
    (SIADH; 253.6), dehydration, diet, and congestive heart failure. Per coding
    directives, if dehydration is documented with hyponatremia, assign only a
    code for the hyponatremia (276.1). In addition, if the patient has SIADH
    and hyponatremia, only code 253.6 is assigned. Hyponatremia is an integral
    part of the SIADH and would not be coded separately (*AHA Coding Clinic for
    ICD-9-CM*, 1993, fifth issue, page 8).
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