# Adverse Effect coding



## nanaks (Apr 2, 2015)

Hi everybody, I'm taking ICD-10 online class from AAPC. But I'm confused, because the work book and online lecture are not matching. Here is the question. 

A patient took a dose of penicillin that was prescribed correctly resulting in projectile vomiting.

A) R11.12 Projectile vomiting
    T36.0X5A Adverse effect of penicillin, initial encounter  

B) T36.0X5A Adverse effect of penicillin, initial encounter  
    R11.12 Projectile vomiting

Which answer is correct?? A or B? Work book says A, but online lecture says B..

If the sequence is same as ICD-9, then A is correct I believe, but how about ICD-10?

Please help!

Thanks.


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## mitchellde (Apr 3, 2015)

Read your ICD-10 CM guidelines:
When coding an adverse effect of a drug that has been correctly prescribed and properly administered, assign the appropriate code for the nature of the adverse effect followed by the appropriate code for the adverse effect of the drug (T36-T50). The code for the drug should have a 5th or 6th character “5” (for example T36.0X5-).
I am not sure why the lecture is incorrect, I would message the AAPC regarding this.


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## BenCrocker (Apr 3, 2015)

Yes, I always thought T codes came after the reason.


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## mitchellde (Apr 3, 2015)

Poisoning is just the opposit though Ben, when coding a poisoning you always code the T code for the drug first followed by the reaction. This too is stated in the coding guidelines.


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## BenCrocker (Apr 3, 2015)

Well yes, but only if it's the reason. Reason comes first.


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## mitchellde (Apr 3, 2015)

Not sure I undrestand what you mean.  If the patient presents with some type of a reaction, such as cardiac arrest, if the cardiac arrest is due to a drug overdose such as cocaine where the patient accidentally ingest too much causing a cardiac arrest, the T code for poisoning by cocaine, accidental is first listed followed by the code for the cardiac arrest.
Guidelines state:
When coding a poisoning or reaction to the improper use of a medication (e.g., overdose, wrong substance given or taken in error, wrong route of administration), first assign the appropriate code from categories T36- T50. The poisoning codes have an associated intent as their 5th or 6th character (accidental, intentional self- harm, assault and undetermined.  Use additional code(s) for all manifestations of poisonings.


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