Coding of electrolyte diagnosis when lab is wnl but patient is on routine supplementation

greenbedo

Our coders were not coding any electrolyte abnormalities that had a normal lab value even though the provider had documented the diagnosis and the patient was on supplementation

For example, a patient had a lab value on the day of admission of 3.6 which was in the normal range for our institution.

The physician documented the diagnosis of hypokalemia and noted that the patient was on KCl po supplementation bid.

CDI coded the diagnosis of hypokalemia noting that although the lab value was normal, the diagnosis was requiring treatment and monitoring to maintain normalcy. The code was noted as POA.

The coder maintained that only when the lab value went below the normal range should this diagnosis be coded.

What is the general consensus on this?

In addition, for  a cardiac patient, who might have a normal K level, say of 3.7, the cardiologist might document hypokalemia noting that for this patient population the goal for K supplementation is > 4.0.  CDI chose to code the hypokalemia diagnosis that was documented, on the basis that the 3.7 level was not considered optimal for this patient and required treatment and monitoring.

Do you agree?

whitneyarellano

Coding guidelines clearly state that code assignment should be based on the provider's statement that the diagnosis exists - NOT the criteria used to make the diagnosis. Regardless of whether the diagnosis met the coder's clinical criteria, it met the provider's and it should be coded as such. Coding clinic also supports this - see 4th Q 2018 pg 79-80 for Morbid Obesity. The coding clinic notes that regardless of the patient's BMI being < or > 40, if the provider documents morbid obesity, that is what should be coded.