Laureen: Yeah...
Alright, now I think we go back to your gestational diabetes.
Alicia: Q: I want to code 648.8 for gestational diabetes.
I do NOT need a 250 code with that, correct?
Because 250 codes EXCLUDE gestational diabetes.
Right?
-- Dawn
A: She's right.
Let's see here, 648.8 is the code for gestational diabetes.
If you look at 648.80 -abnormal glucose tolerance, complicating pregnancy/childbirth; unspecified
episode of care.
If you go to 250.00 which is your normal type II diabetic code, you will see that it has
an Excludes and there's an Excludes for several things but I got rid of everything except
for gestational diabetes.
It even tells you 648.8 is where you want to go to look for the proper code if it's
gestational diabetes.
Now, that being said, I went ahead and got some more information on gestational diabetes
because sometimes if you understand the disease process it will help you to find the codes
and to understand that gestational diabetes is nothing like type I or type II diabetes.
It is diabetes that is only when you're pregnant.
So, they have high blood sugar, during pregnancy and that's it; as soon as the baby is born
it just goes away.
They have found that 18% of women in their pregnancies get gestational diabetes, and
you can have it at one time and not have it another.
They don't know the cause, but they do know it has something to do with the placenta that
supports the baby when it grows; that hormones from the placenta help the baby develop, but
these hormones also block the action of the mother's insulin in the body, so this problem
is called insulinresistance, and it makes hard for the mother's body to use the insulin
so she may actually produce three times as much insulin as needed.
Gestational diabetes starts when your body is not able to make and use all the insulin
that your body is producing for the baby and the mother, and without enough insulin the
glucose can't be turned into energy.
There was a great website that this came from, but ultimately what happens is that glucose
builds up in the blood and it just gets too high and you have hyperglycemia.
You can, a lot of times, just regulate that insulin by diet and exercise, but sometimes
it's bad enough that you would have to take a medication, take a pill maybe; but there
are incidences where women actually have to take insulin injections.
I don't know how common that is, but I do know that when they test you and they do that
glucose tolerance test, they do it about the time, it's like a 20-some weeks, because that's
whenit usually exhibits itself.
Again, as soon as that baby is born, your body goes back to normal and you may never
have problems again.
It doesn't matter what size you are.
You can be a very thin, healthy, never have had a history of sugar problems in you or
your family, or you can bea big woman and rather unhealthy.
It just doesn't matter.
It has more to do with the placenta, and there's nothing that you can do to stop it either,
that it's either going to happen or it's not.
That being said, it is diabetes but it is diabetes that comes on and goes in relation
to the pregnancy, so it's not coded 250.00, it is actually coded in the 600s.
Laureen: Alright, very good.
Alicia: And that's a great website there by the way.
Laureen: Why don't we go back to this one, just some follow-up questions if you didn't
mind, and then we'll let Boyd merge them together.
Sorry, Boyd.
Alicia: Is that the one, is someone saying something about the third degree?
I saw that question pop up.
Let's see here, if you go and you look up that code which is the --
Laureen: What's the question so that everyone can know what we're trying to answer?
Alicia: Q: They were wanting to know on the first scenario, if a person has a first degree
burn, how come it's being coded in the third degree section?
A: The T21.11 is for first degree, but I think they're talking about the T31.11.
If you go and you look at that code, I think that's a generalized code.
They're not saying they don't have a code for 1st degree, 2nd, and 3rd degree...
I'm going to pull up my book at the same time...
Yeah, you got to tell it's to ICD-10.
I really like using Find-A-Code.
See it says: Burns involving 10-19% of the body surface area with 10-19% third degree.
The way I understand this, it is not saying it has to be third degree, but they're saying
that if 10-19% is third degree.
Now, if you have an ICD-10 and you go look at it, T31, if you go and you look at that,
there's not a code for body surface for 1st degree and body surface for 3rd degree, and
that's why you're using that code.
Laureen: Alright.
Alicia: Yeah.
Laureen: We can come back to these two, if --
Alicia: Yeah, go ahead, if you do your slide I will look that up.
Laureen: OK.
Alicia: And confirm that, and even you probably have the same ICD-10 that I do and I will
give you a page number.
Laureen: Because I think this digit here is we're supposed to add up the TBSA (Total Body
Surface Area), and then the last digit is supposed to be that is 3rd degree or worse
like a deep 3rd, or 3rd with loss of body part.
Alicia: Yeah.
If you go and you look at all the T31s, it mentions 3rd degree in every single one of
them.
So, it says it's like 0-9% 3rd degree burns, it's inclusive.
Laureen: OK.
Alicia: If you go and you look, your T31 through T32.99 you'll see that every single one of
those in green, it says "with" and then it gives you a TBSA in 3rd degree.