Diabetic Ketoacidosis Documentation Guide
Acute metabolic emergency with hyperglycemia, ketosis, and metabolic acidosis.
ICD-10 Codes: E10.10, E10.11, E11.65, E13.10, E13.11
Common Symptoms
- Nausea and vomiting
- Abdominal pain
- Kussmaul breathing
- Altered mental status
- Fruity breath odor
Key Documentation Elements
- DKA severity (pH, bicarb, anion gap, mental status)
- Insulin infusion rate and transition to subcutaneous
- Serial BMP results and anion gap trend
- Precipitating cause (noncompliance, infection, new-onset)
- Fluid resuscitation and electrolyte replacement
Documentation Challenges
- Documenting DKA severity classification (mild, moderate, severe)
- Recording insulin drip protocol and titration details
- Capturing serial metabolic panel trends and anion gap closure
- Tracking precipitating factor identification and treatment
Billing Considerations
- Type 1 (E10.10/E10.11) vs Type 2 (E11.65) DKA coding
- With vs without coma distinction for severity
- Critical care time documentation for severe DKA
Frequently Asked Questions
How is DKA coded differently for Type 1 vs Type 2?
Type 1 DKA uses E10.10 (without coma) or E10.11 (with coma). Type 2 DKA uses E11.65. Scribeable selects based on your documented diabetes type and mental status assessment.
How does Scribeable support DKA management documentation?
Scribeable captures serial labs, insulin drip adjustments, fluid resuscitation volumes, and anion gap closure from your encounter, creating time-stamped documentation that supports critical care billing.