# Coumadin Toxicity & Digoxin Toxicity



## JGALAPIA

I have seen these dx coded as Coumadin Toxicity V58.61 & 964.2 and Digoxin Toxicity V58.69 & 972.1. I also seen these dx just coded as V58.61 and/or V58.69. 
Which is the correct dx to use?
Thanks


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## magnolia1

What about adding "E-codes" in addition to the 964.2 & 972.1?


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## dawndi67

I was taught that when a pt has a toxicity to a drug you code the symptom with the therapeutic e-code from the table of drugs and chemicals. You dont use the 900# that is only for poisonings. Toxicity is not a poisoning it is an adverse reaction to a prescribed medication taken by the pt correctly. Please feel free to correct me if I am wrong.


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## adbegin

dawndi67 said:


> I was taught that when a pt has a toxicity to a drug you code the symptom with the therapeutic e-code from the table of drugs and chemicals. You dont use the 900# that is only for poisonings. Toxicity is not a poisoning it is an adverse reaction to a prescribed medication taken by the pt correctly. Please feel free to correct me if I am wrong.



I have always coded the same way. For example, a patient with generalized weakness due to coumadin toxicity would code to 780.79 and E934.2.


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## kandigrl79

I've never heard that before that toxicity and poisoning are not the same thing, but it could very well be correct.  However, if you look at the definition of the word 'toxicity' in Taber's is says "the extent, quality, or degree of being poisonous."  I usually code the 900 code and then use the appropriate E code.  For example, if the patient used digoxin for therapeutic use like someone said above, I would code 972.1 and E942.1 which indicates that the use was therapeutic.


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## FTessaBartels

*Toxicity = poisoning*

I was also taught that toxicity was, in fact, poisoning. Just because it's a result of therapeutic use doesn't mean that it's not poisoning. 

The use of the appropriate E code to indicate the source of the poisoning is key here. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## Mouf1818

I put "toxicity" through our encoder, and after following all the steps it has you code the manifestation (the symptom) and the E-Code.  No 9xxx code should be used.


Amber, CPC


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## Mouf1818

I did a little bit more research and talked to another coder who was an instructor and this is how you are supposed to code "toxicity" when due to a drug that was properly prescribed and used:

Inpatient-code the effect first (ex. coma, vertigo, etc...) and then the E code from therapeutic use column.  ****In the event that the specified effect is unknown or not documented, 796.0 is reserved for inpatient use.

Outpatient-code the effect first 9ex. coma, vertigo, etc....) and then the E code from therapeutic use column.  ****In the event that the specified effect is unknow or not documented, 995.20-995.29 should be used.

In faye brown, it has a decision tree for coding adverse effects of drugs or poisoning due to drugs or medicinal or biological substances.  Pretty much if the condition is due to a drug that was taken properly, you code the effect and the therapeutic E-code.  If the correct medication wasn't used exactly as prescribed-code as poisoning(use poison code), add code for condition if documented and use ecode E850.x-E869.x.  If the correct medication was used exactly as prescribed but was taken with alcohol and/or a drug not prescribed by the physician-code as poisoning(use poison code), add code for condition if documented and use ecode E850.x-E869.x.

You can find this info in faye brown and basic icd-9-cm coding by ahima and i'm sure it's in more books too.

Hope this helps!

Amber, CPC


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## 00032036

*decision tree*

Does anybody know where I might find a Decision Tree for Adverse effects of Drugs/poisoning?  I used to have an excellant one but don't know where I got it.  Dale


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## mitchellde

The coding guidelines cover this very well.  A poisoning is either the patient intentionally or accidentally takes the medication incorrectly, or the physician precribes the medicaton incorrectly.  Adverse effect is medication that is prescribed corrctly and taken as prescribed and still has a reaction.  Toxicity is a dx that is derived after results of the test reveals levels that in considered in the toxic rang, this could be due to either poisoning or adverse effect.
when coding a poisoning the 9xx.xx code is first listed with the effect secondary followed by the appropriate Ecode.  For adverse effect you code the effect first followed by the E-code adverse effect in therapeutic use.  These are the rules for either outpatient, inpatient, or physician coding.
You would lis the V58.6x codes secondary as they are not allowed first listed


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## ahmed

Toxicity refers to adverse effect of a drug thus coding symptoms followed by an Ecode for Theuraputic usege of the drug will suffice


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## handmaid

796.0 is the code I use for Coumadin Toxicity or Digoxin Toxicity if there is no mention of a specific reaction or problem in the patient.


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## mitchellde

A drug toxicity is referring to the concentration of the drug in the patient's blood.  This toxicity could be due to the patient taking more medication than prescribed, that is an accidental poisoning and is coded using a 9xx.xx code first then the reaction then the E code.  OR the toxicity is due to a metabolic reaction which is an adverse reaction to the medication this is coded as the reaction followed by the E code for the adverse reaction.  It is very important to obtain clear and correct information when coding these as we do not want to communicate an adverse reaction when in fact the patient has incorrectly self administered the drug, or the nurse or even the physician made a mistake in the administration or prescribing of the drug.


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## fredcpc

*Digoxin Toxicity*

My feeling is that for Digoxin Toxicity it is 972.1 then E942.1. Any feedback? Also, what is the Digoxin toxicity cpt...is it 36415?


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