Revenue Cycle Insider

Question: What’s the difference between adverse effect and toxic effect? The ICD-10-CM codes list these in the same table.

Maine Subscriber

Answer: If you look at the Table of Drugs and Chemicals, you’ll see four categories with combination codes from categories T36-T65 (Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances - Toxic effects of substances chiefly nonmedical as to source). These combination codes identify the substance the patient took, as well as the intent. Here’s how ICD-10-CM defines these four categories:

• Adverse effect: Problem that arises after taking a drug that has been correctly prescribed and properly administered
• Poisoning: Reaction to the improper use of a medication
• Underdosing: Taking less of a medication than is prescribed
• Toxic effect: Ingestion or contact with a harmful substance

To code from the Table of Drugs and Chemicals, you need to be able to understand and navigate the differences between adverse effect, poisoning, underdosing, and toxic effect.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC