![]() ![]() You can use noncompliance (Z91.12-, Z91.13-) or complication of care (Y63.6-Y63.9) codes with an underdosing code to indicate intent, if known. If you find your patient has a relapse or exacerbation of the medical condition for which the drug is prescribed due to the reduction in dose, then you should code the medical condition. Underdosing codes should not be assigned as principal or first listed codes. You should first assign appropriate codes from T36-T50 (fifth or sixth character “6”). If a patient is taking less of a medication than is actually prescribed by a provider or instruction provided by the manufacturer, then it is underdosing. K52.1: Toxic gastroenteritis and colitis.T39.311A: Poisoning by propionic acid derivatives, accidental (unintentional), initial encounter.You should use the following codes (in the following sequence) to report that condition. Suppose a person comes to your emergency department with stomach pain and diarrhea after mistakenly taking Aleve instead of another medicine. Use additional codes for all manifestations of poisoning (for example, vomiting, stomach pain, diarrhea). These codes have an associated intent as their 5th or 6th character (accidental, intentional self-harm, assault and undetermined). While coding for poisoning, you should first assign the appropriate codes from T36-T50. Poisoning occurs due to the improper use of a medication (for example, overdose, wrong substance given or taken, wrong route of administration). T45.515A: Adverse effect of anticoagulants, initial encounter.You can report this adverse effect using the following codes (in the following sequence): Suppose that your patient is diagnosed with Hematuria, which occur as a side effect of Coumadin prescribed and administered correctly for atrial fibrillation. You should also report the original condition is being treated using the appropriate code. The code that you use for reporting the drug should have a 5th or 6th character. Examples of the nature of an adverse effect include tachycardia, gastrointestinal hemorrhaging, hepatitis, delirium, renal failure, hypokalemia, vomiting or respiratory failure. If you want to code for an adverse effect of a particular drug that has been prescribed by the doctor correctly and administered in proper manner, first assign the appropriate code for the nature of the adverse effect and then the appropriate code for the adverse effect of the drug (T36-T50). The specific medical coding guidelines for each of the toxic reactions are as follows. If there are two or more drugs, medicinal or biological substances, you should code each of them individually unless a combination code exists.If you find that the same code describes the causative agent, use that code only once.Use as many codes as are necessary to describe completely all medicinal or biological substances.Rather than coding directly from the Table of Drugs, you should always refer back to the Tabular List.The other important things to consider are: No additional external cause code is needed. The seventh character of the code represents episode of care (initial, subsequent or sequela). These are combination codes that specify the substance taken as well as the intent. The codes in categories T36-T65 are for poisonings, toxic effects, adverse effects and underdosing. Before taking a look into each classification, let’s explore the general coding guidelines. However, there is another new classification in ICD-10, known as underdosing and the coding guidelines for this condition are quite different. All these classifications exist in ICD-10-CM medical coding system also and there are not that many changes in the coding guidelines even though defining the differences can be confusing at times. The ICD-9-CM coding system has classified these reactions into adverse effects, poisoning and toxic effects to report on medical claims. The properties of some drugs, medicinal and biological substances or their combinations may cause toxic reactions in patients. ![]()
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