E87.3

Alkalosis

Alkalosis is a clinical condition characterized by an excessive accumulation of base or a significant loss of acid in the body fluids, leading to an arterial blood pH greater than 7.45. It is categorized into two primary types: metabolic and respiratory. Metabolic alkalosis occurs when there is a primary increase in serum bicarbonate (HCO3−), often resulting from the loss of gastric acid (via vomiting or nasogastric suctioning), the use of diuretics (which promote hydrogen ion excretion), or the excessive intake of alkaline substances. Respiratory alkalosis, conversely, is driven by hyperventilation, which causes an excessive loss of carbon dioxide (CO2) from the lungs. The resulting shift in pH can lead to decreased levels of ionized calcium and potassium, manifesting as neuromuscular irritability and potentially serious cardiac arrhythmias. Management focuses on treating the underlying cause, correcting electrolyte imbalances, and restoring the body's acid-base homeostasis.

Clinical Symptoms

  • Muscle twitching
  • Hand tremors
  • Paresthesia (numbness and tingling) of the face and extremities
  • Muscle spasms (tetany)
  • Nausea
  • Vomiting
  • Lightheadedness
  • Dizziness
  • Confusion
  • Stupor
  • Coma
  • Cardiac arrhythmias
  • Rapid breathing (hyperventilation)

Common Causes

  • Prolonged vomiting
  • Nasogastric suctioning
  • Loop or thiazide diuretic therapy
  • Overuse of antacids (Milk-alkali syndrome)
  • Hyperventilation due to anxiety or panic
  • High altitude exposure
  • Pulmonary embolism
  • Early stage salicylate poisoning
  • Excessive administration of sodium bicarbonate
  • Hyperaldosteronism

Documentation & Coding Tips

Distinguish between Metabolic and Respiratory Alkalosis in clinical documentation.

Example: Patient presents with pH 7.52, pCO2 48, and HCO3 34, confirming primary metabolic alkalosis. This is likely secondary to prolonged nasogastric suctioning and diuretic use for chronic congestive heart failure. Documentation includes laterality of symptoms and chronicity of the underlying cardiac condition to support HCC risk adjustment.

Billing Focus: Identify the primary mechanism of alkalosis to ensure accurate mapping to E87.3 versus mixed disorders.

Document the acuity and current clinical stability of the acid-base imbalance.

Example: Acute respiratory alkalosis documented in a patient with an exacerbation of COPD and hyperventilation syndrome. Symptoms include carpopedal spasm and circumoral paresthesia. Severity is noted as moderate, requiring immediate CO2 retention techniques and monitoring of electrolyte shifts, specifically potassium levels.

Billing Focus: The documentation of 'acute' vs 'chronic' supports medical necessity for high-intensity observation or inpatient admission.

Include associated electrolyte abnormalities such as hypokalemia or hypocalcemia.

Example: Metabolic alkalosis documented in the setting of severe hypokalemia (K+ 2.8). Note specifies that the alkalosis is maintaining the hypokalemia due to intracellular shifts. Both E87.3 and E87.6 are coded to reflect the full clinical picture of the metabolic derangement.

Billing Focus: Coding for concurrent electrolyte disorders ensures the billing reflects the increased resources required for multi-ion correction.

Specify the role of medications in the development of alkalosis.

Example: Iatrogenic metabolic alkalosis resulting from high-dose loop diuretic therapy (Furosemide) for pulmonary edema. Documented plan to hold diuretics and initiate acetazolamide for correction. The documentation links the medication to the diagnosis for clear clinical logic.

Billing Focus: Documentation of iatrogenic causes helps distinguish primary metabolic disorders from external drug-induced effects.

Detail the compensatory response in the assessment and plan.

Example: Metabolic alkalosis with partial respiratory compensation documented by increased pCO2. Patient has underlying chronic renal failure (Stage 3a). The documentation explicitly links the acid-base status to the renal impairment, which is a major diagnostic contributor.

Billing Focus: Linking the acid-base disorder to a chronic systemic disease like CKD supports the highest level of specificity.

Relevant CPT Codes

Related Diagnoses

Hierarchy