OASIS Alert

Tip: Toxicity isn't the same as poisoning.

Many clinicians and coders think you don't have to use E codes in home health -- but sometimes E codes are required.
    
Basics: E codes describe the external causes of injury and poisoning. They describe the "how, where and why of injuries and adverse events," said home health coding expert Sparkle Sparks with Redmond, WA-based OASIS Answers, during her recent Eli audio conference, "Everything You Always Wanted to Know About V & E Codes But Were Afraid to Ask."
    
Reporting E codes is generally optional in home care. But when a patient suffers an adverse effect from a medication properly prescribed and taken or administered correctly, you are required to use an E code to describe the circumstances, Sparks explained. The specific coding guidance stating the requirement comes from section I.C.19.c.7 in the coding manual, and you'll find the codes in the series E930 to E949, she instructed.
    
How To Know When To Turn To E Codes

Follow these tips from Sparks to be sure you don't skip E codes when they're required:
    
1. Look for terms that indicate therapeutic use. Remember you are looking for properly prescribed and administered medication, which still resulted in problems. Words such as "allergic," "idiosyncratic,"  "paradoxical," "cumulative effects' or "toxicity," should prompt you to look to E codes, Sparks said.
    
Heads up: Be careful of the term "toxicity," Sparks warns. It may sound like a poisoning but really means the same as "cumulative effect." This situation may happen if a patient isn't metabolizing a drug adequately and it builds up in the blood.

2. Remember poisoning doesn't require E code use. Terms in the medical record that may indicate poisoning include: "Wrong substance," "wrong person," "wrong dose," "overdose" or "intoxication." "With poisoning, the word you see over and over again is 'wrong,'" Sparks said.

3. Sequence the codes correctly. To describe an adverse effect due to an external cause, sequence what happened to the patient first, followed by the E code that indicates which drug or drugs were responsible.
    
Example: Your patient has a bleeding gastric ulcer due to aspirin intake for rheumatoid arthritis. The patient has correctly taken the aspirin, which was properly prescribed for the rheumatoid arthritis. For this patient, Sparks suggests listing:

    • M0230a: 531.40 (Gastric ulcer; chronic or unspecified with hemorrhage);
    • M0240b: E935.3 (Drugs, medicinal and biological substances causing adverse effects in therapeutic use; aspirin); and
    • M0240c: 714.0 (Rheumatoid arthritis).
    
Code 531.40 explains what the adverse event was -- what happened to the patient. Next, E code E935.3 describes the cause of the adverse event. Listing 714.0 explains why the patient was taking the aspirin and paints a more complete picture, Sparks says. 
    
Note: For more detailed home health diagnosis coding information, order Eli's Home Health ICD-9 Alert at www.elihealthcare.com or by calling 1-800-874-9180. Order a copy of Sparks' audio conference at www.audioeducator. com (enter "Sparks" in the search box), or call 1-800-508-2582.