Gestational Diabetes Medical Coding | Medical Coding Tutorial
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Gestational Diabetes Medical Coding | Medical Coding Tutorial

November 1, 2019

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.

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