Home Health ICD-9/ICD-10 Alert

Question 1: Your patient has Alzheimer's disease with severe dementia and a behavioral disorder. She took Acetylsalicylic acid (aspirin) several times due to her memory problem, resulting in an overdose of aspirin which caused toxic encephalopathy. How should you code this scenario?

Question 2: Your patient took an antihistamine medication for allergies. The medication was prescribed by his physician and taken as instructed, but your patient experienced double vision as a result of taking the antihistamine. How should you code this scenario?

Answer to Question 1: In this scenario, the patient has experienced a poisoning, says Jun Mapili, PT, MAEd, with Global Home Care in Troy, MI. Poisonings happen when something was done incorrectly, he says.

Poisonings may be a result of a number of factors, Mapili says. There may have been a mistake made in the drug prescription (wrong drug was given); error in drug administration by the physician, nurse, patient, or other person; an overdose of a drug may have been taken intentionally or accidentally; or a non-prescribed drug or medicinal agent may have been taken with a correctly prescribed and properly administered drug (drug interaction).

To code for a poisoning, you need to follow three steps, Mapili says.

Step 1: List the poisoning code from the 960-979 categories.

Step 2: Document the condition resulting from poisoning.

Step 3: List E-codes to indicate the circumstances of the poisoning.

In the Question 1 example scenario, you would first list the poisoning code for the medication in question: 965.1 (Poisoning by analgesics, antipyretics, and antirheumatics; salicylates).

Follow this by the condition which resulted from poisoning, 349.82 (Toxic encephalopathy).

Next, list the external cause for the poisoning -- E850.3 (Accidental poisoning by analgesics, antipyretics, and antirheumatics; salicylates)

Then list the comorbidities: 331.0 (Alzheimer's disease) and 294.11 (Dementia in conditions classified elsewhere with behavioral disturbance).

Answer to Question 2: This is an example of adverse effects, Mapili says. Adverse effects occur when a drug has been correctly prescribed and properly administered, but the patient experiences an adverse effect such as toxicity, synergistic reaction, side effect, or idiosyncratic reaction.

To code for adverse effects, Mapili suggests following these two steps:

Step1: List the code for the adverse effect.

Step2: List an E code to document the drug responsible.

In the Question 2 example scenario, the first thing to do is sequence the adverse effect: 368.2 (Diplopia).

Follow this with the drug that caused the side effect: E933.0 (Drugs, medicinal and biological substances causing adverse effects in therapeutic use; antiallergic and antiemetic drugs).