This podcast will focus on poisoning,
toxic effects, adverse effects and the
underdosing of drugs. By definition, an
adverse effect is when you've got a
condition caused by a drug or another
substance that was used correctly and
it's just created an adverse effect for
the patient. Poisoning is a condition
that's caused by a drug or substance
that's used incorrectly . A toxic effect
is a condition caused by ingestion or
contact with a harmful substance.
Underdosing is a condition caused by
taking less of a medication than is
prescribed by a provider or a
manufacturer's instructions. When we're
coding an adverse effect, we're going to
put the code that indicates the nature
of the adverse effect first and then
the combination code, which is in the T
codes, that includes the adverse effect
and the responsible substance following.
That's the range of T36 -T50. When
coding an adverse effect of a drug that
has been correctly prescribed and
properly administered, assign the
appropriate code for the adverse effect
of the drug T36 -T50. The code
for the drug should have a 5th or
6th character "5" to indicate it is
an adverse effect.
Here's an example. Coumadin intoxication,
coumadin intoxication due to a
cumulative effect resulting in gross
hematuria, initial encounter. We're going
to code the gross hematuria first. That's
the nature of the adverse effect and
then by going to the Table of Drugs and
Chemicals and looking up "coumadin" in the
adverse effect column, we get T45.515
adding the 7th character "A"
because this is an initial encounter.
When coding a poisoning or a reaction to
the improper use of a medication, that
could be an overdose, the wrong substance
given or taken in error, the wrong route
of administration, you're going to assign
the appropriate code from categories
T36 -T50 and the poisoning codes have
an associated intent as their 5th or
6th character. The associated
intent is referring to whether it was an
accidental intent, was it intentionally meant
to harm oneself or another person or is
it undetermined. Use additional codes for
all manifestations of poisonings.
If there is also a diagnosis of abuse or
dependence of the substance, the abuse or
the dependence is assigned as an
additional code. Example of poisonings
that would be an error made in a drug
prescription, an overdose of a drug
intentionally taken, a non-prescribed
drug taken with a correctly prescribed
and properly administered drug, and an
interaction between a drug and alcohol.
So here's an example. 2 year old patient
ingested an unknown quantity of his
mother's Enovid, which is birth control medication,
initial encounter. If you could not find
the medication by name in the Table of
Drugs and Chemicals, you could search for
the name of that drug or the
classification of that drug using the
search engine on your desktop to find
out what type of medication it is and
what is used for. Go into the Table of
Drugs and Chemicals and looking up Enovid,
it is there and you're going to go
to the accidental poisoning column. 7th
character "A" is added to indicate this is
an initial encounter.
Again, is an adverse effect or is it
poisoning? The determination is based
only on whether or not the substance was
correctly prescribed and properly
administered. If it was correctly
prescribed and administered , it is an adverse
effect. If it was incorrectly prescribed
and/or administered. it is poisoning. Now
let's look at underdosing. Underdosing
codes should never be assigned as a
principal or first listed codes . If the
reduction in the prescribed dose results
in a relapse or an exacerbation of a
medical condition for which the drug was
prescribed, the medical condition itself
should be coded first and then you're going to
add non-compliance or a complication of
care along with the underdosing code to
indicate intent, if you know it.
Here's an example. Patient was admitted
for treatment due to complications from
diabetes type 2 which include
polyneuropathy and proliferative
retinopathy with macular edem. Patient
was using an insulin pump at home,
however, she told the physician it had
not been working correctly for some time
and she found out this morning from a
service technician, the pump was not
delivering the full prescribed dose of
insulin. So, it is an "underdosing" because
of the pump malfunction.
There is a guideline specific to
underdosing of insulin in the Chapter 4
guidelines where the underdose of
the insulin due to insulin pump failure,
underdose is assigned to a code from
subcategory T85.6- mechanical
complication of a device and then you're
going to add the T38 code for under-
dosing of the insulin. Then, of course,
you're going to add your diabetes codes.
So there's an example of underdosing. I
know I've gone through these quite
quickly so please be careful reading your
coding guidelines, using the proper sequence
of your codes. If you have any questions
with anything to do with the coding
assignments, please put your question in
the discussion board along with the path
that you used to try to find the answer
and I'll be glad to try to help you.
Thank you. Have a good day.