Question

Family members bring a girl, age 16, to the ED after she collapsed. They state she has type 1 diabetes and has used an insulin pump for several years. She had been doing well until earlier in the day when she complained of feeling weak. Shortly after that, she collapsed. Evaluation in the ED shows the insulin pump had malfunctioned and was not dispensing enough insulin. She is admitted to the ICU for treatment of a ketoacidotic coma caused by underdosing related to insulin pump failure.

What is the coding and sequencing for this case?

A. T85.611A, T38.3X6A, E10.65
B. E10.11, T85.614A, E16.1
C. T38.3X6A, E10.11
D. T85.614A, T38.3X6A, E10.11

Answer 1

The appropriate medical coding for a 16-year-old girl in ketoacidotic coma due to a malfunctioning insulin pump is E10.11 (Type 1 diabetes mellitus with ketoacidosis), followed by T85.614A (Breakdown of insulin pump) and T38.3X6A (Underdosing of insulin). This reflects the primary diagnosis and the underlying causes.

Step-by-step explanation:

The correct coding and sequencing for the case of a 16-year-old girl admitted to the ICU for treatment of a ketoacidotic coma caused by an underdosing of insulin related to insulin pump failure would primarily depend on the codes provided within the context of the International Classification of Diseases (ICD). Based on the information given, the sequence seems to emphasize the diabetic ketoacidosis (DKA) due to the malfunctioning pump. So, a likely coding would be:

1. E10.11 - Type 1 diabetes mellitus with ketoacidosis.
2. T85.614A - Breakdown (mechanical) of insulin pump, initial encounter.
3. T38.3X6A - Underdosing of insulin and analogs, initial encounter.

This sequence indicates that the primary diagnosis is diabetic ketoacidosis followed by the malfunctioning of the insulin pump and the underdosing of insulin, stressing that the medical issue originated with diabetes management complications. It is important for medical coding and billing professionals to choose codes and sequence them in a way that most accurately reflects the patient's clinical situation for proper documentation and billing purposes.