Thursday, July 28, 2016

3 Macrovascular Risks of Uncontrolled Diabetes Mellitus

Uncontrolled diabetes mellitus (either type 1 or type 2) is associated with several complications caused by the chronic damage that excess glucose causes to the tissues of the body. The vascular tissue, is particularly sensitive and leads to the damage of organs as we are going to see.

Coronary Artery Disease (CAD). Diabetics have a higher rate of heart attacks than the general population. Excess glucose over many years contribute to the generation of atherosclerosis and the formation of plaques in the coronary arteries that will eventually be the cause of the heart attacks. Heart attacks, are also the main cause for heart failure and sudden death.

Cerebrovascular Disease (CVD). A similar problem in the vascular system of the brain is responsible for the appearance of more strokes in diabetics than in the general public. In this case, the atherosclerosis and the plaques are formed in the carotid arteries and the arteries of the brain. Debilitating strokes, and dementia are the main consequences.

Peripheral Artery Disease (PAD). If the atherosclerosis and plaque formation happens in the arteries of the lower extremities, the consequence may be the amputation of different parts of the leg. These can range from losing toes to the loss of an entire limb. It is well known that diabetics have a higher incidence of amputations than non-diabetics

Strict control of the blood sugar is the mainstay of the prevention of these complications. To get to the point of a heart attack, a stroke or an amputation, decades of elevated blood sugar have to be present. In addition, other factors such as smoking, high blood pressure, or genetic predisposition can speed up the process of atherosclerosis. There are many options to control the blood sugar, including many pharmacologic measures such as oral medications and injectables such as insulin and non-pharmacological measures such as diet and exercise.

Marco A. Ramos MD

Friday, July 15, 2016

Tips for Great Clinical Documentation Part 1.

As I explained in the previous post of the series, Clinical Documentation Improvement (CDI) is a recognized process of improving records to ensure improved patient outcomes, data quality and accurate reimbursement1. In order to achieve great documentation before the need for a Clinical Documentation Specialist (CDS) queries a medical provider, there are some tips that are usually useful. In this post I will present a few of these, with more tips coming in the next post.

Be Specific

By being specific I mean, to describe the condition as much as you can un terms that are accepted by all practitioners and coding specialists. For example, you should always indicate the stage of a condition, e.g, it is not enough to document chronic kidney disease (CKD) alone. It is important to say if this is a stage III, or a stage IV CKD. Treating a more severe condition, represents that more resources are being used because the patient is sicker. Also, the type of condition that the provider is dealing with is necessary to be known, for example, if the chronic heart failure is of a systolic type or a diastolic type. Treatment, may be different between those conditions and establishing the difference might have an impact in retrospective research. Finally, specifying the chronicity of an illness (acute or chronic) is important. An example of this is anemia. Having a hemoglobin concentration of 7.0 g/dL is different if this is a consequence of a gastrointestinal hemorrhage or if this is a level that has been maintained for years, like in patients with sickle cell anemia. The first patient will need a gastroenterology consultation with a possible endoscopic procedure, the second patient will need careful monitoring and possible advise from a hematologist.

Marco A. Ramos MD
Second Medical Opinions PLC
Physician Advisor in Clinical Documentation


1. Retrieved June 2, 2016