wording of query question

Unknown

I have a patient diagnoses of hyperglycemia secondary to steroids
HbA1C = 7.3 eAG = 163
random glucose range = 84-359
bedside glucose range = 95 - 387
patient is on a sliding scale

Based on the above clinical indicators and treatment what is the diagnosis you are monitoring and treating?

Question to CDI talk: is there a better way to word this?


Charlene

Unknown

I forgot to say I am looking for steroid induced diabetes.
Charlene

nbrunson84

You could offer choices - with the diagnosis being one of the choices as
well as "Other"...



Or, "What is the significance of this evaluation and treatment?"



Or, "Please document medical necessity of the above evaluation and
treatment."



Just suggestions...





N. Brunson, RHIA

Clinical Documentation Specialist

Bay Medical Center

mannb1

I d/w one of our coders here. They think MD already stated is steroid induced, due to the phrase "hyperglycemia secondary to steroids", if that is indeed the diagnosis stated - not sure why you would query here? Am I missing something?

Becky Mann, RN, CDS

Unknown

I don't know. Hyperglycemia and diabetes have different codes -
I don't think one assume it is diabetes if it is not stated as so.


Charlene

robert.hodges2

Steroid induced hyperglycemia is very common. If a patient has diabetes
and the provider has documented that the hyperglycemia is due to the
steroids, I won't request clarification. On the other hand, I have seen
'diabetes type 2 - uncontrolled due to steroids". In that case I may
ask what the impact of the steroids is on the diabetes that is causing
it to be uncontrolled after I've talked it over with a coder to see if
it will make an impact on the final DRG assignment.



Robert



Robert S. Hodges, BSN, MSN, RN

Clinical Documentation Improvement Specialist

Aleda E. Lutz VAMC

Mail Code 136

1500 Weiss Street

Saginaw MI 48602



P: 989-497-2500 x13101

F: 989-321-4912

E: Robert.Hodges2@va.gov



"To climb a steep hill requires a slow pace at first." -William
Shakespeare

Unknown

The glitch is no diabetes documented, just hyperglycemia secondary to steroids.


Charlene

dallend@einstein.edu

I have a question. Did this condition develop while inpt or is this an ongoing issue? Based on the A1C I would think it started prior to admission.
That being said
I would give the MD options as far as choices one of them being secondary diabetes due to steroids controlled vs uncontrolled. other, unknown and his original verbiage. He may not think of this patient as a diabetic. Perhaps he thinks this will be a short lived condition. We have a difficult time with our attendings with this one also. We do have an excellent endocrine team who usually saves the day for us.

Unknown

no mention of previous hyperglycemia or diabetes


Charlene

dallend@einstein.edu

If there is no mention of previous hyperglycemia or DM I would not query. The physician has given a valid diagnosis - unless there is something else documented in the chart to lead you toward DM I would have to leave it be.

bea.smith

I had a chart yesterday I verbally talked with the physician about.
Patient came in with COPD exac, treated with steroids and glucose
steadily increased after admission. They monitored with fasting blood
sugars and treated with moderate scale insulin. There was no
documentation of DM in record, patient did not have a hx of it. In
talking with the physician, he said that the steroids had "uncovered"
new onset diabetes and documented as such. Honestly, I thought he was
going to say steroid induced hyperglycemia. Just something to think
about.

dog

Isn't hyperglycemia really just a description of a lab value rather than a meaningful diagnosis? I think the OP could legitimately ask, especially given the elevated A1C, if the patient may have progressed to steroid diabetes.

Renee

Linda Renee Brown, RN, CCRN, CCDS
Clinical Documentation Specialist
Arizona Heart Hospital

Unknown

This is my feelings - what exactly is steroid induced hyperglycemia? I don't think there is a code for it. I am going to try to catch the doctor in the morning for a face to face interaction.

Charlene

Unknown

According to 3M encoder, drug induced diabetes is a non-essential
modifier for secondary diabetes category (249xx)unless due to
overdose/wrong substance given, then codes to poisoning.

robert.hodges2

I'm sure not a coder, but I would suspect an E code would be applied as an effect of the medication. The E code looks to be E932.0. But hyperglycemia NOS (790.29) does exclude diabetes as a cause. The code for adverse effects of steroids, correct substance properly administered is 255.8.

All the coders out there help me out here!

Robert

Robert S. Hodges, BSN, MSN, RN
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602

dallend@einstein.edu

We have many patients who have COPD - blood sugars go up while they are on steroids and once they are tapered down the issue resolves - MD documents hyperglycemia due to steroids. We code the hyperglycemia.
If the patient is being dc'd on insulin, etc - DM educator consulted - we would query.

nbrunson84

Agree. You would need the physician to document "Steroid -induced Diabetes" to use the 429.xx code. Otherwise you are going to be stuck w/Hyperglycemia and an E Code.

If this is a SDx - I wouldn't sweat it too much - it's not a CC or MCC. (and actually the Hyperglycemia has a higher weight than the Sec. Diabetes)

However - if it caused the patient to stay an extra day for monitoring/dietary/diabetes education I might go for the Query for medical necessity.

Unknown

To all who gave their input, I spoke with the physician this morning, told him I was unsure. . . he responded this is most likely steroid induced diabetes.


Charlene