Diabetic Ketoacidosis – Symptoms, Diagnosis and ICD-10 Codes

Hello everyone and welcome to our podcast series! My name is Natalie Tornese. I am a Senior Solutions Manager at Outsource Strategies International (OSI). I wanted to talk a little bit about diabetes ketoacidosis. Diabetes ketoacidosis is also abbreviated as DKA and I may use that abbreviation during this podcast.

Diabetes ketoacidosis occurs when your body produces high levels of ketones. The condition develops when your body does not have enough insulin to process high levels of glucose in the blood. Glucose is a major source of energy for your muscles and other tissues Insulin plays a major role in regulating the glucose entering your cells. Without adequate insulin, your body begins to break down fat as fuel called ketones, which causes the blood to become acidic. Ketones are normally produced when the body breaks down fat after a long time between meals. When ketones are produced too quickly and build up in the blood and urine, they can be toxic by making the blood acidic and leading to a condition called ketoacidosis. If left untreated, this condition can lead to serious complications like loss of consciousness, coma, or even death. Physicians treating this diabetes-related disorder need to educate patients about the risks of this condition and prevent it by identifying the warning signs early, and checking the urine and blood sugar level early as well.

According to the Centers for Disease Control, diabetic ketoacidosis affects approximately 30 million people in the US and the rate of the hospitalizations increased a total of 54.9%, per 1,000 people with diabetes. Each year, there was more than just 6% rise in DKA hospitalizations annually across all age groups, with the highest rates among people under 45 years old. High levels of ketones can poison your body and is a warning sign that your diabetes is too high and is getting out of control. This most commonly affects people with Type 1 diabetes, but can at times also occur in people with Type 2. The condition is usually triggered by prolonged uncontrolled blood sugar, missing doses of your medicine or a severe illness or infection and a problem with insulin therapy. Other possible triggers include physical or emotional trauma, heart attack, alcohol or drug abuse, and use of certain medications, such as corticosteroids and some diuretics.

Generally, DKA signs and symptoms can develop quickly, sometimes within 24 hours. For some people, these symptoms may be the initial indication of having chronic diabetes. Other symptoms include – excessive thirst, weakness or fatigue, shortness of breath, nausea, vomiting, obviously high levels of ketones in the urine, high blood sugar levels, fruity-scented breath, frequent urination, dry mouth and skin, confusion, abdominal pain and a flushed face.

If your physician suspects diabetic ketoacidosis, he may or she may conduct a physical exam along with blood tests to diagnose the condition.  In some cases, additional tests may be recommended to determine which potential risks or risk factors triggered in. One of the first steps for diagnosis is testing for ketones in a sample of urine. Blood tests used in the diagnosis of DKA will measure blood sugar level, ketone levels, and blood acidity. Other additional tests include basic blood electrolytes, arterial blood gas, blood pressure, urinalysis, routine chest X-ray, EKGs, and other tests to check for signs of infection.

Treatment modalities generally comprise a combination of approaches to normalize blood sugar and insulin levels. People who get diagnosed, but have not yet been diagnosed with diabetes, will be treated with a clear plan for diabetes prevention to keep ketoacidosis from recurring. On the other hand, if the ketoacidosis is a result of an infection or illness, your doctor will treat that as well, usually with antibiotics. Common treatment options include fluid replacement, insulin therapy and electrolyte replacement.

Diabetes screening is provided as preventative care services under the Affordable Care Act. I will include a transcript of all associated ICD-10 coding for this condition along with this podcast.

• E10 – Type 1 diabetes mellitus
  • 10.1 – Type 1 diabetes mellitus with ketoacidosis
    • 10.10 – Type 1 diabetes mellitus with ketoacidosis, without coma
    • 1011 – Type 1 diabetes mellitus with ketoacidosis, with coma

Diabetes is a lifelong condition so incorporating healthy lifestyle changes can help slow or even stop the progression of the condition.  Proper management of your blood sugar level is one of the best ways to prevent diabetic ketoacidosis. Other additional steps to prevent the occurrence of DKA include – consuming diabetes medication regularly as prescribed by your physician, monitoring your blood sugar at frequent intervals and adjusting your insulin dosage as needed under a doctor supervision ofcourse, check your ketone levels, follow a healthy meal plan and stay hydrated with water.

I hope this helps, always remember that documentation and a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you for listening.