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Home Health ICD-9/ICD-10 Alert

You Be the Coder:

Hone in on Sequencing for Adverse Effects

Published on Tue May 15, 2012

Question: Our patient had two medication bottles, one labeled "Digoxin" and the other labeled "Lanoxin." He has been taking the prescribed amount from both bottles, causing low heart rate and toxicity. We are providing skilled nursing for observation and assessment, teaching, and venipuncture. How should we code for him?

Answer: List the following codes for this patient, says Trish Twombly, BSN, RN, HCS-D, CHCE, COS-C, HCS-O, director of coding with Foundation Management Services in Denton, Texas.

  • M1020a: 972.1 (Poisoning by cardiotonic glycosides and drugs of similar action);
  • M1022b: 427.89 (Other specified cardiac dysrhythmias);
  • M1022c: E858.3 (Accidental poisoning by agents primarily affecting cardiovascular system);
  • M1022d: V58.83 (Encounter for therapeutic drug monitoring); and
  • M1022e: V58.69 (Long term [current] use of other medications).

Your patient's low heart rate is due to an accidental poisoning. He took too much digoxin because he was confused by the different labels on his medication.

When coding for a poisoning, you list the code for the poisoning first, in this case 972.1 for poisoning by glycosides.

Next, list the symptom produced by the poisoning -- his low heart rate, or bradycardia.

Finally, list an E code to describe the poisoning. Remember, E codes are required in home health when your patient experiences a poisoning or an adverse event with a drug or chemical. Listing E codes for injury and trauma is optional in home health, but is a best practice.

If your patient's low heart rate and toxicity were the result of his correctly taking the prescribed amount of digoxin rather than an accidental poisoning, your sequencing would be different, Twombly says.

In this scenario, your patient has suffered an adverse event would list the symptom caused first, followed by the E code for therapeutic use, Twombly says. So your coding would look like this:

  • M1020a: 427.89 (Other specified cardiac dysrhythmias);
  • M1022b: E942.1 (Adverse effects in therapeutic use of cardiotonic glycosides and drugs of similar action);
  • M1022c: V58.83 (Encounter for therapeutic drug monitoring); and
  • M1022d: V58.69 (Long term [current] use of other medications)..

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