# icd9 failure oral antibotics



## mamacase1 (Dec 13, 2010)

I have a doctor who has tried oral antibotic on patient with cellulitis. He has put a DX of failure on oral antibotic. What ICD9 code would you use.


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## btadlock1 (Dec 13, 2010)

Like MRSA?


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## btadlock1 (Dec 13, 2010)

Check the alphabetic for "Resistance to Drugs", then find the appropriate antibiotc that failed (They're in the V09.X area in the tabular). List the cellulitis first, though - the fact that the antibiotic failed is secondary to the reason the patient had to take it in the first place.


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## mamacase1 (Dec 13, 2010)

thank you sooo much


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## preserene (Dec 13, 2010)

"Icd9 failure oral antibotics
I have a doctor who has tried oral antibotic on patient with cellulitis. He has put a DX of failure on oral antibotic. What ICD9 code would you use."-Quote.

Well Btadlock 1, let me first appreciate all the responses you give in the forum, I have been watching through. It is tremendous and awesome. I like and appreciate your talents!

This one you have given is closer  but I feel that we cannot take it as a "drug resistance" because the documentation is ONLY for "oral administration"  as for now. To label a drug to be resistant, it should be resistant to all routes of administration; even those category of "without mention of resisitance to multiple drugs" also do not suit because the organism has to be first of all deemed to be resistant organism which is lacking in our document.
So where would we go for more appropriate? It is hard to find in our ICD manual.

I though for a moment whether V15.81 'noncompliance with medical treatment'. Hither too I wonder whether the "noncompliance is a term exclusive for the patients part or the drug noncompliance too?!


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## btadlock1 (Dec 13, 2010)

preserene said:


> "Icd9 failure oral antibotics
> I have a doctor who has tried oral antibotic on patient with cellulitis. He has put a DX of failure on oral antibotic. What ICD9 code would you use."-Quote.
> 
> Well Btadlock 1, let me first appreciate all the responses you give in the forum, I have been watching through. It is tremendous and awesome. I like and appreciate your talents!
> ...




Why, thank you! I have entirely too much free time, and I like to figure out answers to stuff, myself, so the forum has become a little hobby for me lately...

I see your point, and I'm not well-versed enough in the medicine side of things to know for sure, but if an infection is resistant to a particular antibiotic given in oral form, would it be any more likely to be susceptible to the drug if given another way? (for example, if giving a penicillin orally didn't clear up an infection, would the doctor try giving a shot of it, or would they just try another antibiotic?) I would think the route of administration would be a moot point, if not. (Again, I really don't know how that works...)

The reason I went with the resistance to drug category is because that's how I interpreted "antibiotic failure" - I probably should have asked more about that. What exactly "failed" about it? My immediate assumption was that it failed to treat the infection, which implies that the organism is resistant to the drug (in my opinion). But if the diagnosis listed is really describing the patient's inability to take the antiobiotic orally, which would also make sense, I'd probably code the encounter with something more specific to the reason that the oral administration failed. (eg - if the patient can't swallow the pill and is in the office to have the treatment re-assessed because of that, I code the cellulitis, then dysphagia). The noncompliance code you mentioned doesn't specify whether the noncompliance was  intentional or not, so I'd think it would be applicable in that situation as well.

Another code that looked like it might fit somehow is V58.83 - Encounter for therapeutic drug monitoring - it's got a definition note that says " Drug monitoring: measurement of the level of a specific drug in the body, or measurement of a specific function to assess effectiveness of a drug.". It's an aftercare code, though, which indicates that the condition is healing, and treatment is not being directed at a current, acute disease. (The conventions just say to code the disease diagnosis, otherwise.) 

I guess I'd have to see the more of the picture to get a better idea of what the doctor was talking about with the diagnosis listed...I'm interested to see how others would code this...


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## preserene (Dec 13, 2010)

That is great and you are doing a good lot. Medicine is always a practice and we continue to learn always.
Oral compliance may be on the part of the patient  and her/his systems when she fails to take regularly, reluctant to take, forget to comply with ,OR her systems fail, like you said, disphagia, or any gastric problem, absorption problem, and intolerance, or any intestinal surgery or some metabolic/systemic diseases (even some types of anemia).
well, whatever be the cause for the noncompliance, one thing we are sure is: there is  some factors for noncompliance of oral drugs(antibiotics here).
So I feel more convinced with the  "NONCOMPLIANCE" if I am  correct with my vocabulary

Yes, it is so. When an organism is deemed to be resistant, it is resistant for that drug in any form. Having said that I should also state that the term failure differs from 'resistant in that it could be as you and I narrated above or failure in absorption  so much so that the needed MIC level in the blood of the drug is not reached to show its effectiveness.


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