Inpatient Facility Coding & Compliance Alert

Question: A patient was admitted to the hospital with hematuria which the physician suspected was due to Coumadin toxicity. Documentation showed that the patient was taking Coumadin as prescribed. The patient was finally diagnosed with coagulopathy secondary to Coumadin toxicity. Which condition should be the primary diagnosis: hematuria, coagulopathy, or abnormal coagulation profile as a secondary effect of long-term Coumadin use?

Pennsylvania Subscriber

Answer: You are absolutely right in shifting away from Coumadin toxicity (or poisoning) to an adverse effect. Hematuria can be an adverse effect of anticoagulants such as Coumadin, and actually is expected to occur. The situation you describe is not poisoning since the medication was correctly prescribed and administered. 

The primary diagnosis will be the adverse reaction of the drug, which in this case is hematuria (599.70, Hematuria; unspecified). The secondary diagnoses are V58.61 (Long-term [current] use of anticoagulants) and E934.2 (Anticoagulants). You could also include 790.92 (Other nonspecific findings on examination of blood; abnormal coagulation profile) as a secondary diagnosis, but don’t submit it as the primary.

Note: A code from category 286 (Coagulation defects) is not appropriate for patients on anticoagulant therapy because the codes in this family describe congenital complications.