# Need help with E-Code, RX abuse



## Orthocoderpgu (Oct 24, 2008)

I would appreciate a second opinion please. Here's the situation: Patient is prescribed 4 pills of phenobarbitol per day. Patient states that her ex-husband is monitering her Rx's and is giving her 5 pills a day ( If that story is true). Our doc confirmed with the pharmacy that the instructions were to only take 4 pills daily and the doc noted in the patient's chart that the patient has a history of taking more of this Rx than prescribed. I gues we don't really know for sure that the patient's ex-husband is actually in control of her medication or not, but what we do know is that the patient is taking more than she should and should know that she is taking more than she should. I want to code this as E950.1, not because there was any suicide attempt or ideation but because the patient is knowingly taking more medication than is being prescribed. Am I off base or should this be coded as unknown since we really don't know who is in charge of the RX?


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## coder03 (Oct 24, 2008)

*non compliance*

you fail to mention if the patient is toxic at this point, or is just not compliant with the directions of the medications.  i personnally would code this as undetermined, until further follow up is done, i would also code the non-compliance.


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## Orthocoderpgu (Oct 24, 2008)

Sorry, the patient was toxic at the time of this exam.


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## FTessaBartels (Oct 24, 2008)

*Not E950.1*

I still would NOT code the E950.1 unless the physician specifically stated that the patient was suicidal.  

I'd use either the "accidental" or "undetermined."

F Tessa Bartels, CPC, CPC-E/M


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## Orthocoderpgu (Oct 27, 2008)

My reasoning for choosing E850.1 was not that the patient was attempting any suicide. But at the beginning of the table it says to use E950-E952 for "instances in which...poisionings are invlolved". After reading the dictation a few times, it seems clear that the patient is probably intentionally taking more pills than prescribed.


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## FTessaBartels (Oct 28, 2008)

*Suicidal - NOT*

The ICD9 guidelines at the beginning of the table define these codes as:
*Suicide Attempt (E950-E952) *- instances in which self-inflicted injuries or poisonings are involved.

The practical application and use of the E950-E952 codes is that they are interpreted to mean a *suicide attempt*. This is a huge red flag on a patient's medical record which may affect his/her ability to get employment or  insurance in the future (Life, disability or health).

If there is ANY question, do *not *use these codes. Use them ONLY when the patient is truly suicidal as documented by the physician. 

The definition of Undertermined seems to more clearly fit your case:
*Undetermined (E980-E982)* - to be used when the *intent* of the poisoning or injury *cannot be determined *whether it was intentional or accidental. (emphasis added by FTB)

You say that After reading the dictation a few times, it seems clear that the patient is *probably* intentionally taking more pills than prescribed (emphasis added by FTB)
I think "probably" is your key. That word is NOT certainty. 
If you don't think it's accidental, then use Undetermined. 
Use the "Suicide attempt" code ONLY if the physician has specifically documented it as such. 

We all see patient files where we might be tempted to make a judgment as to the patient's intent / abuse of drugs. It is NOT our role to judge the patient. It is our role to code the chart based on the physician's documentation (however frustrating that may be at times).

F Tessa Bartels, CPC, CPC-E/M


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## dmaec (Oct 28, 2008)

I would NOT use E950.1 !!  I'd use either E851 "accident" - or E937.0 "therapeutic use" because that's why she's taking the meds - for therapeutic reasons... UNLESS the documentations states she is attempting suicide in some way???... otherwise, she's simply taking more of the meds then allowed -she's simply over medicating...for whatever reason
this sounds more of a case of a non-compliant patient than suicide attempt.


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