Pediatric Coding Alert

Question: For an electrocardiogram (ECG) (93000-93010, Electrocardiogram, routine ECG with at least 12 leads ...) done to monitor medication (stimulant, antipsychotic), should I use late effect of medication code 909.5?

Ohio Subscriber

Answer: No, you should instead use V58.69 (Long-term [current] use of other medications), which is for monitoring of other high-risk medications, such as Ritalin, as the secondary diagnosis. The ICD-9-CM Coding Guidelines V code table lists V58.69 as an additional code only. For the primary diagnosis, use the reason why the patient is on the medication -- for instance, attention deficit disorder of childhood with hyperactivity (314.01). A late effect is the conditions produced after the acute phase of an illness or injury has terminated, according to 2009 ICD-9-CM Coding Guidelines, Section 1, B, 12.

Example: An adolescent boy presented with light-headedness (780.4, Dizziness and giddiness), and blurred vision (368.8, Other specified visual disturbances) after taking a prescribed dose of insulin.

The dizziness and blurred vision have been corrected, but the diabetic patient continues to suffer from a moderate headache. When this occurs, you would assign a late effect code as the secondary diagnosis. Code the remaining effect first (784.0, Headache) and then the late effect (909.5, Late effect of adverse effect of drug, medical or biological substance), according to ICD guidelines.

Information for You Be the Coder and Reader Questions provided by Suzan Berman-Hvizdash, CPC, CEMC, CEDC, Sr. Manager of Coding and Compliance for the Departments of Surgery and Anesthesiology at the University of Pittsburgh Medical Center; Jeffrey F. Linzer Sr., MD, MICP, FAAP, FACEP, associate medical director of compliance and business affairs for the division of pediatric emergency medicine, Department of Pediatrics at Children's Healthcare of Atlanta at Egleston; and Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville.