# Coagulopathy



## kyannekis (Oct 20, 2017)

If a patient's INR is elevated due to the use of Coumadin which codes do you use?  I am using R791, T45515A and Z7901 but have also seen D689 used instead of R791.

Thanks


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## kak6 (Nov 6, 2017)

T45.515A when caused by drugs you have to use Drug section


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## mitchellde (Nov 6, 2017)

D68.9 is absolutely incorrect for this scenario.  D68.9 is for when the provider has rendered a diagnosis of a coagulation defect.  There are many articles which have been published by the AMA stating this is incorrect.  The coder cannot assign a code based on a lab result and cannot determine the diagnosis.  If the provider documents that the result is abnormal and is a result of the Coumadin being correctly taken then you would use adverse effect.  However the provider must document this.  If the coder sees a low or elevated result there is no code that can be assigned for this, it is just information not a diagnosis.  
So the question is then what exactly did the provider document or are you looking only at the lab result.  if the purpose of the encounter was to draw the blood to check the result and all you have then is a lab result with no provider interpretation as to the result is indeed elevated then you would jut use drug monitoring Z51.81 and the Z79.01.  If the provider only documents that the lab is elevated then you could only use the R79.1.  Only if the provider documents that the elevation is in fact an adverse effect of the Coumadin can you use the adverse effect of drug.  It might not be an adverse effect, it may be that the patient took more than they should which would be  a poisoning, and it may not be due to the Coumadin administration at all, it may be that the provider has yet to determine the correct dosage for the patient.


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