Home Health ICD-9/ICD-10 Alert

Hint: Never list an E code as primary.

Make sure your coding for poisonings and external causes of adverse effects passes muster with these tips from Sparkle Sparks, MPT, HCS-D, COS-C, consultant with Redmond, WA-based OASIS Answers.

Don't end your search in the Table of Drugs and Chemicals. While you'll locate the likely codes in the Table of Drugs and Chemicals, you shouldn't assign them directly from this section. "The Table of Drugs and Chemicals is part of the alphabetic index, and any code you get from the alphabetic index must be verified with the tabular list," Sparks says.

Never report an E code as a primary diagnosis. An E code should be used as an additional code to one from the main chapters of the ICD-9-CM, indicating the nature or the circumstances around that condition, Sparks says.

Don't limit yourself to one code. Use as many codes as necessary to describe all the drugs or substances involved, Sparks says. However, in some cases, the same E code describes the causative agent for more than one adverse reaction, so you only need to report that E code once, she says. And when two or more drugs or substances are reported, code each individually unless there is a combination code listed in the table that covers both drugs.

Know how to handle alcohol. When a reaction results from the interaction of a drug and alcohol, assign poisoning codes and E codes for both substances. This is an example of an intoxication, Sparks says. Taking drugs and alcohol together is never just an adverse effect.