Adverse effects and poisonings in ICD-10-CM
One of the challenges in ICD-10-CM is understanding the difference between coding for adverse effects and poisonings. And to understand the coding differences, the difference between the two, has to be understood. In the ICD-10-CM draft manual, the columns have changed. Now the ?therapeutic column? has been deleted from the table, and a new column for ?adverse effect? has been added. The poisoning column no longer exists but has been replaced by several columns that read: ?poisoning accidental (unintentional)?, ?poisoning Intentional/self-inflicted?, ?poisoning assault?, and ?poisoning undetermined.? A new column has been added to identify ?underdosing,? which seems to be an increasing problem.
For adverse effects, ICD-10-CM guidelines states, ?Codes in categories T36-T65 are combination codes that include the substances related to the adverse effects, poisonings, toxic effects and underdosing, as well as the external cause. No additional external cause code is required for poisonings, toxic effects, adverse effects and underdosing codes.? According to the guidelines, the T36-T65 code would be the first listed code. Also the code(s) that specify the ?reaction? or as ICD-10-CM calls it ?the nature of the adverse effect, poisoning, or toxic effect can be reported.?
Always refer back to the tabular list, before coding directly from the table.
Codes should be used to completely describe all drugs, medicinal, or biological substances.
The code should be assigned only once, if the same code would describe the causative agent for more than one adverse effect, poisoning, toxic effect, or underdosing. Unless the combination code is listed in the table of drugs and chemicals, two or more drugs, medicinal or biological substances are reported, each individually.
Poisoning, Adverse Effects and Underdosing of Drugs.
Codes in categories T36?T65 are combination codes that include substances related to adverse effects, poisonings, toxic effects, and underdosing, as well as the external cause. For poisonings, toxic effects, adverse effects, and underdosing codes, no additional external cause code is required. A code from categories T36?T65 is sequenced first, followed by the code that specifies the nature of the adverse effect, poisoning, or toxic effect. This sequencing instruction does not apply to underdosing codes (fifth or sixth character “6”; e.g.T36.0x6).
When the drug is correctly prescribed and properly administered, coders should assign the appropriate code for adverse effect (e.g., T36.0x5-). Additional codes should be used for all manifestations of adverse effects. Examples of manifestations are:
- Tachycardia,
- Delirium,
- Gastrointestinal hemorrhaging,
- Vomiting,
- Hypokalemia,
- Hepatitis,
- Kidney failure,
- Respiratory failure.
Assign the appropriate code from categories T36?T50, when coding a poisoning or reaction to the improper use of a medication (e.g: overdose, wrong substance given or taken in error, wrong route of administration). Poisoning codes have an associated intent:
- Accidental,
- Intentional self-harm,
- Assault, and
- Use additional code(s) for all manifestations of poisonings.
Code to accidental, when no intent of poisoning is indicated. Undetermined intent is only for use when there is specific documentation in the record that the intent of the poisoning cannot be determined. The correct code should be directed to the type of drug or substance that was responsible for the patient?s condition and the intent of being exposed. In addition, determining whether the patient was poisoned , suffered an adverse effect, or suffered a toxic effect must be justified.