# Adverse Reaction code



## ShelleyM (Jan 30, 2014)

Can anyone help me with the code for Morphine allergy resulting in hypotension?  I know the hypotension code, but the morphine allergy has me stumped!  Thank you in advance!


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## mitchellde (Jan 30, 2014)

code the hypotension and the E code for adverse reaction to the morphine E935.2


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## ShelleyM (Jan 30, 2014)

Thank you Mitchell, I really appreciate the help.  I am doing a code-a-round for CEUs.  I plugged in that E code and it says it's incorrect.  So, I must be missing a different code.  I'll keep trying and see what I've missed.
Thanks again!


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## mitchellde (Jan 30, 2014)

The AHA coding clinics have answered this question and that has been their answer, to code the hypotension and then the E code.  Then it is probably wanting the 995.27 other drug allergy which includes morphine, but I would still use the E code.


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## ShelleyM (Jan 31, 2014)

Mitchell, that code is not working either.  I give up, have no idea what I'm doing wrong.  I'm going to post below the Impression/Plan and the codes I have used - the grader still says I'm missing 1 or more codes.

ASSESSMENT:  1.  The patient is noted to have cholestatic liver chemistries and an abnormal CT scan of the abdomen and HIDA scan. She is suspect for cholecystitis and possible common bile duct calculi because of cholestatic liver chemistries and resultant jaundice, rule out primary biliary cirrhosis.
2.       The patient's abdominal CT scan also indicates abnormal antrum, rule out metastatic disease to porta hepatis with obstructive chemistries and also involvement of the antrum.
3.   History of ovarian cancer with subsequent surgery which consisted of total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy, and chemotherapy for Stage 4 ovarian cancer.
4.  Hypertension.   
5.  Type 2 diabetes.    
6. The patient is allergic to morphine.
7.  Exogenous obesity.

PLAN:  The patient was scheduled for an esophagogastroduodenoscopy initially because of abnormal CT scan findings. She had cholestatic chemistries. She will have ultrasound of the gallbladder to make sure there are no gallbladder calculi. CT scan did not show this, though. The patient is also have anti-methacholine antibodies to rule out primary biliary cirrhosis. The patient is to get vitamin K in view of mild hypoprothrombinemia. The patient also will have an endoscopic retrograde cholangiopancreatography.

The patient showed extreme frustration and repeatedly complained that they have been at it with pains for two months, and she is not getting any definite answers. I had a long conversation with the patient's twin sister, her husband, her daughter and her son to alleviate their fears. I explained the ERCP in detail, with the indications and inherent risks and complications, and the fact that I had ordered a magnetic resonance cholangiopancreatography, which did not show any definite common bile duct calculi, and the reason for undertaking ERCP.  

I have discussed the patient with Dr. David Figg in the past. Her prognosis is guarded in view of multiple problems encountered. I will follow the patient and define the actual pathology.
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CPT 99253       
ICD9 401.9       
ICD9 V10.43       
ICD9 250.00       
ICD9 278.00       
ICD9 787.01       
ICD9 789.09


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## mitchellde (Jan 31, 2014)

Ok there is no hypotension due to morphine documented which is what your original post was about.  the fact that the patient is allergic to morphine is not coded.  there is no nausea and vomiting documented and no abdominal pain documented.  You have not coded the abnormal test results nor the hypoprothrombinemia, nor the acquired absence of organs.  Look those codes up and drop the ones not in the documentation and see what happens.


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## ShelleyM (Jan 31, 2014)

Ok, will do. Thank you! Will post again when I have it figured out.


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## ShelleyM (Feb 8, 2014)

It turns out that I was only missing the code for the abnormal abdominal CT scan.  Craziness!  I'm just glad I'm done with that one!

Thanks again for your assistance, it is much appreciated!!!!


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