ED Coding and Reimbursement Alert

ICD-9 2010 contains several new additions to the poisoning by antidepressant code set.

Avoid tainting your claims with invalid diagnoses: check out this list of new poisoning diagnoses, which will take effect on Oct. 1.

Until Oct. 1, you should continue to code poisoning by any antidepressant with 969.0 (Poisoning by psychotropic agents; antidepressants); when ICD-9 2010 begins, however, this coding subset will explode with these new options:

• 969.00 -- Poisoning by antidepressant; unspecified

• 969.01 -- ... monoamine oxidase inhibitors

• 969.02 -- ... selective serotonin and norepinephrine reuptake inhibitors

• 969.03 ... selective serotonin reuptake inhibitors

• 969.04 -- ... tetracyclic antidepressants

• 969.05 -- ... tricyclic antidepressants

• 969.09 -- ... other antidepressants

• 969.70 -- ... psychostimulant, unspecified

• 969.71 -- ... caffeine

• 969.72 -- ... amphetamines

• 969.73 -- ... methylphenidate

• 969.79 -- ... other psychostimulants.

Impact: This is big news. "People do come to the ED with antidepressant poisoning, and now there are very specific codes as to the type of antidepressant," says Jim Strafford, CEDC, MCS-P, vice president of client services with Omega Healthcare.

Example: A 2-year-old patient presents to the ED via ambulance; she is suffering from sinus tachycardia and drowsiness. The patient ingested a large number of her mother's tricyclic antidepressant pills (the mother had a prescription for the medicine to treat her chronic pain syndrome). The physician stabilizes the patient during a level-five ED E/M service.

For this 99285 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: a comprehensive history; a comprehensive examination; and medical decision making of high complexity ...) scenario, report the following ICD-9 codes:

• 969.05 to represent the antidepressant type

• 427.89 (Other specified cardiac dysrhythmias; other) for the tachycardia

• 780.09 (Alteration of consciousness; other) for the drowsiness

• E854.0 (Accidental poisoning by other psychotropic agents; antidepressants) to represent the accidental nature of the overdose.

"With the specificity of diagnosis codes, the potential risk would be more identifiable," says Sarah Todt, RN, CPC, CEDC, associate director for QA and compliance at MRSI, Inc., in Woburn, Mass.

Example: A selective serotonin reuptake inhibitors (SSRI) overdose (969.03) might not be as severe as a tricyclic antidepressant overdose (969.05), Todt says.