Electrolyte Disorders

Electrolyte imbalances are defined as electrolyte levels that fall outside the normal reference ranges established by institutional laboratories.

Management of these imbalances typically includes correction of the abnormal values, daily monitoring of electrolyte levels, and, when indicated, electrocardiogram (EKG) and cardiac monitoring. 

Hypoelectrolytemia (low electrolyte levels) is commonly addressed through oral or intravenous replacement, identification and treatment of the underlying cause, and discontinuation of any contributing medications.

Hyperelectrolytemia (high electrolyte levels) may require more complex management due to the risk of associated complications, necessitating close monitoring and supportive are. 

Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) involves excessive release of antidiuretic hormone (ADH) and is characterized by hyponatremia that is unresponsive to standard treatment protocols.

Diagnostic Criteria

* Example of normal electrolyte reference ranges (varies by institution)

Coding Considerations

• The ICD-10-CM codes for hyponatremia (E87.1) and hypernatremia (E87.0) are classified as Complications or Comorbidities (CCs) and are associated with a Severity of Illness (SOI) score of 2. 
• Electrolyte disorders are included as Vizient quality variables across numerous Diagnosis-Related Groups (DRGs). 
• Accurate provider documentation is essential. Descriptive terms such as “low sodium” are not equivalent to a medical diagnosis and do not support code assignment. A formal diagnostic term (e.g., hyponatremia) must be documented.
• Code assignment for electrolyte imbalances requires evidence of clinical significance, such as treatment, monitoring, or an extended length of stay related to the condition.

CDI Practice Considerations

In patients admitted with elevated blood glucose levels and low sodium, the presentation may reflect pseudohyponatremia. In such cases, it is important to determine whether the sodium level is truly low by performing a corrected sodium calculation. This can be done using a sodium correction formula for hyperglycemia ( e.g. Sodium Correction for Hyperglycemia).

Query opportunities to review for when patients have electrolyte abnormalities:

• Acute Kidney Injury (AKI): May be associated with dehydration and electrolyte imbalance.
• SIADH: Consider when sodium levels are unresponsive to standard treatment. 
• Congestive Heart Failure (CHF): Patients may present with fluid overload, contributing to electrolyte disturbances.  
• Metabolic Encephalopathy: Significant deviations in sodium levels can lead to altered mental status. When sodium is corrected and the patient returns to baseline, review for the presence of metabolic encephalopathy and query as necessary. 
• Symptom PDx: When the principal diagnosis is a symptom code (e.g., confusion, syncope, weakness), there may be an opportunity to query the provider to determine and document an underlying etiology-such as an electrolyte imbalance-to establish a more clinically specific and diagnostically meaningful principal diagnosis. 

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