Q&A: Diabetic ketoacidosis in COVID-19 patients

Q: I am seeing many patients who manifest diabetic ketoacidosis (DKA) and COVID-19 symptoms with provider documentation indicating that the COVID-19 infection likely drove the DKA. I have been sequencing COVID-19 as the principal diagnosis, but our coding team wants to use the DKA.

The documentation includes symptoms of both as present on admission, including ground glass opacities and DKA, but of course test result is unknown at admission. DKA is readily apparent at admission and treated with insulin. What are your thoughts?

A: If you look in the Official Guidelines for Coding and Reporting, there are no instructional notes under the DKA while the COVID-19 states to “Use additional code to identify pneumonia or other manifestations.” If you have documentation that the COVID-19 caused the DKA, then the COVID-19 should be the principal diagnosis. 

Per the FAQs from the American Hospital Association/American Health Information Management Association:

When COVID-19 meets the definition of principal or first-listed diagnosis, code U07.1, COVID-19, should be sequenced first, and followed by the appropriate codes for associated manifestations, except in the case of obstetric patients. However, if COVID-19 does not meet the definition of principal or first-listed diagnosis (e.g., when it develops after admission), then code U07.1 should be used as a secondary diagnosis.

Editor’s note: This question was answered by Nancy Franciotti, RN, BS, CCDS, CDI manager at Inspira Health in Woodbury, New Jersey. Franciotti is a member of the ACDIS CDI Leadership Council. To learn more about the Council, click here.