Question

The patient is a 70-year-old female who was a former office employee of her primary care physician. She had called the doctor's office three days prior to admission complaining of general weakness and nausea, and, according to her niece who checked in on her every few days, was apparently not able to get around her house very well. The physician advised her to come to the office, and she agreed but did not show up. The patient had often been noncompliant with medications and treatments recommended. When the doctor's office called her after she failed to show, she said she did not feel well enough to drive but her niece would drive her to the doctor's office the next day. The patient did not show up the next day either. On the third day, the doctor's office called her again. When she sounded less responsive on the telephone, one of the doctor's office staff nurses was given permission to go to the house to check on the patient. When the nurse got to the home, she found the front door unlocked and the patient in bed very lethargic, feverish, and not responding clearly to questions. An ambulance was called, and the patient was brought to the Emergency Department and admit­ ted as an inpatient. The patient was known to have type 1 diabetes with several body systems affected. She was also known to have alcohol dependence, consuming a pint of vodka on a daily basis. Initial laboratory work showed a glucose level of 245, urinalysis with 3+ bacteria and greater than 150 white cells with 10-20 RBCs, a positive blood alcohol level indicating acute intoxication, and ketoacidosis. A urine culture grew E. coli bacteria. She was started on IV antibiotics. She improved steadily and described herself as feeling the best she had felt in a long time. She was watched closely for signs of alcohol withdrawal, but nothing obvious was noted. During her hospital stay, the following conditions were treated: diabetes mellitus, type 1, with ketoacidosis with coma; diabetes mellitus with worsening nephropathy; diabetic severe nonproliferative retinopathy and macular edema; E. coli urinary tract infection; history of UTIs; alcohol dependence; and noncompliance with medical care. The attending physician was queried and documented that the diabetic ketoacidosis best met the definition of principal diagnosis. A social work consultation was requested, and the patient and her niece were given information about assisted living centers to help the patient live safely with some medical supervision. However, the patient flatly refused to consider the option and was discharged home with home health services requested for medical management. Please code seven ICD-10-CM codes for this scenario.

Answer 1