Part B Insider (Multispecialty) Coding Alert

Question: A patient comes to the office after taking 15 Paxil, nine Ativan, and ingesting six or seven cocktails in an attempt to kill herself. She is lethargic, has low blood pressure,and isn't breathing steadily. What codes would describe this situation?

Oregon Subscriber

Answer: Because the patient is having difficulty breathing, the physician would likely perform a stomach lavage and order an electrocardiogram. She then would read the EKG and perform a complete history and physical exam. Because the patient is too lethargic to participate, the doctor would probably speak to the family and ask them to rummage through the patient's belongings to find the pill bottles.

In this case, you should report 43753 (Gastric intubation and aspiration[s] therapeutic, necessitating physician's skill [e.g., for gastrointestinal hemorrhage], including lavage if performed) for the stomach lavage, and 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) for the EKG interpretation (if they are well-documented). In addition, you should bill the appropriate E/M code.

As for the ICD-9 codes, you should report the following:

• 969.0 -- Poisoning; antidepressants
• 969.4 -- Poisoning; benzodiazepine
• 980.0 -- Toxic effect; ethyl alcohol
• E950.4 -- Suicide and self-inflicted poisoning by solid or liquid substances; other specified drugs and medicinal substances
• E950.9 -- ... other and unspecified solid and liquid substances.