# Diagnosis



## nabernhardt (Feb 20, 2012)

I have 2 different diagnosis on two separate patients that I am struggling with on how to code.
One is inappropriate antibiotic usage resulting in fungal colonization of bladder.  960.9?

The second is loss of intrisIC factor. If I do deficiency intrinsic factor leads to 281.0? but not sure if thats really what I want to use.

Just wanting some second opinions please.
thanks


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## mjb5019 (Feb 20, 2012)

*antibiotic use*

We can't call it adverse effect therapeutic use;there is no self medicating code. I even looked and there is no code for patient stupidity. Maybe icd 10 will have one. How did you end up coding it?


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## mitchellde (Feb 20, 2012)

inappropriate usage would come under the heading of poisoning, accidental.


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## nabernhardt (Feb 20, 2012)

I went with the poisoning code for antibiotics.

What is your suggestion for loss of intrinsic factor? thanks


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## mitchellde (Feb 20, 2012)

I am at a loss on this one as it is out of context for me.  Can you give me the entire statement from the physician, I might be able to help more.


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## nabernhardt (Feb 21, 2012)

unfortunately that is all the physician wrote was loss of intrinsic factor.  I even tried a query for more info but got nowhere.  The patient is also status post gastrectomy was an additional diagnosis if that would help any.
Thank you.


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## mjb5019 (Feb 21, 2012)

*antibiotic*

Would this be a case where you could use the nondependent abuse of a drug?See Note under 305 as  it mentions self medicating.  305.9 says other drug abuse - Nonprescribed use of drugs or patent medicinals?


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## nabernhardt (Feb 25, 2012)

didnt think about using the drug abuse code. thanks

still stuck on loss of intrinsic factor.  totally clueless on this one.

does anyone have a suggestion maybe. thanks


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## mitchellde (Feb 25, 2012)

well the only thing I can think of here is that, intrinsic factor is needed to for the body to absorb Vitamin B12. And it is secreted thru the digestive system so if there is not a code specific to loss of intrinsic factor then go with other disorder of digestive system.  It is one of the causes of pernicious anemia but I would hesitate to use that dx.


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## nabernhardt (Feb 25, 2012)

thank you. I was also hesitant to use that dx where the dr didnt document it as pernicous anemia.


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## vj_tiwari (Mar 5, 2012)

Hey 

Can we use Vitamin B12 deficiency code 266.2 for this???

Pernicious anemia (also known as Biermer's anemia, Addison's anemia, or Addison–Biermer anemia) is one of many types of the larger family of megaloblastic anemias. It is caused by loss of gastric parietal cells which are responsible, in part, for the secretion of intrinsic factor, a protein essential for subsequent absorption of vitamin B12 in the ileum.

Usually seated in an atrophic gastritis, the autoimmune destruction of gastric parietal cells leads to a lack of intrinsic factor. Since the absorption from the gut of normal dietary amounts of vitamin B12 is dependent on intrinsic factor, the loss of intrinsic factor leads to vitamin B12 deficiency. While the term 'pernicious anemia' is sometimes also incorrectly used to indicate megaloblastic anemia due to any cause of vitamin B12 deficiency, its proper usage refers to that caused by atrophic gastritis, parietal cell loss, and lack of intrinsic factor only.

The loss of ability to absorb vitamin B12 is the most common cause of adult vitamin B12 deficiency. Such a loss may be due to pernicious anemia (with loss of intrinsic factor) or to a number of other conditions that decrease production of gastric acid, which also plays a part in absorption of vitamin B12 from foods.

Pernicious anemia is often used synonymously with vitamin B12 deficiency. However, pernicious anemia specifically refers to anemia resulting from vitamin B12 deficiency caused by an autoimmune metaplastic atrophic gastritis with loss of intrinsic factor 

And also as per causes of Vitamin B12 deficiency, Lack of intrinsic factor (due to pernicious anemia, destruction of gastric mucosa, gastric surgery, or gastric bypass surgery)
Intrinsic factor inhibition
Decreased acid secretion
Small-bowel disorders (eg, inflammatory bowel disease, sprue, cancer, biliary or pancreatic disorders)
Competition for vitamin B12 (in fish tapeworm infestation or blind loop syndrome)
AIDS


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