# adverse effects of corticosteroids on diabetes



## grepay (Sep 3, 2018)

Hello. I am confused on the sequencing of steriod-induced diabetes mellitus due to the prolonged use of corticosteroids. Subsequent visit for the diabetes. The drug was discontinued at the previous visit.
E09.9 and T38.0X5D 

The answer I am being given is sequence the T38. code first followed by the E09 code.

However, ICD 10 states under E09 Drug or Chemical induced diabetes mellitus:

Use Additional

    code for adverse effect, if applicable, to identify drug (T36-T50
    with fifth or sixth character 5)

Code First

    poisoning due to drug or toxin, if applicable (T36
    -T65
    with fifth or sixth character 1-4 or 6)

The answer given seems to go against the guidelines. 
Is the diabetes a manifestation of the steroid use or an adverse effect? 
If it gets sequenced second- why?


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## KokilaVenkatesan (Sep 4, 2018)

*steriod-induced diabetes mellitus*

steriod-induced diabetes mellitus

Sequence 1---E09.9-- Drug or chemical induced diabetes mellitus without complications
Sequence 2---T38.0X5A--Adverse effect of glucocorticoids and synthetic analogues, initial encounter

Diabetes is an adverse effect of corticosteriod use.

Kokila Venkatesan, CPC-A


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## mitchellde (Sep 4, 2018)

The rule for sequencing will depend on whether it is an adverse effect or a poisoning.  An adverse effect is when the patient follows directions and the drug does not work out like it was planned.  A poisoning is when a person takes more or is given more of a drug than the directions allowed for.  If you read in the guidelines it will tell you that for adverse effects you sequence the T code for the substance second and sequence the result first.  for poisonings you will sequence the T code for the substance first and the result secondary.


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## grepay (Sep 4, 2018)

Ok. Thank you.

This is what I thought; however, the course I am taking through AHIMA had it the other way around in the answer key. The question was presented as an adverse reaction not a poisoning. A rationale was not provided with the answer key. I was certain in this case the answer key was wrong but I wanted to be sure about that.


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## kseverson (Sep 6, 2018)

Hi Debra!

would you mind if I emailed you personally a coding question?
thank you


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## angiewelbern@cox.net (Sep 14, 2018)

*Which came first - the chicken or the egg? LOL*

This is what I thought as well, but the Encoder is giving me an error when I try to make Diabetes the primary diagnosis code.  It tells me (in my case) T43.595D should be primary.  But when I move it to the primary position, I get another error telling me that I need to sequence the nature of the adverse effect first UGH!!!  I think I'm going to leave Diabetes as primary & just ignore the Encoder.



mitchellde said:


> The rule for sequencing will depend on whether it is an adverse effect or a poisoning.  An adverse effect is when the patient follows directions and the drug does not work out like it was planned.  A poisoning is when a person takes more or is given more of a drug than the directions allowed for.  If you read in the guidelines it will tell you that for adverse effects you sequence the T code for the substance second and sequence the result first.  for poisonings you will sequence the T code for the substance first and the result secondary.


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## uma.viba (Feb 25, 2019)

*Coding adverse effects  scenario in long term use of medicine*

Hi Frens!
Can anyone immediately help me out to clarify whether we can use long term use of any medication code ( Z79) along with the adverse effext caused by the long term medication ( T39.XXX-).
Iam confused, my mind says we can use both T39.-  and a Z79.- code together to indicate this long term usage has caused the adverse reaction. 

Any helping hands !!1????


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