Wiki Dx code for prescribing "just in case"

[massmtngirl]

Hey there,

So I have a provider who, in two separate encounters, has prescribed a patient medication in case they become ill. The first was for a patient taking a hunting trip, who was prescribed an antibiotic if he were to present with respiratory issues (no previous history of, currently healthy). The other is for a patient traveling out of country who was prescribed something if he were to present with "travelers diarrhea" again no previous history. The only code I was able to come up with was Z29.9 Encounter for prophylactic measures, unspecified. The problem I find with this code is these medications are not preventive, they are "just in case" the patient gets sick. I feel Z29.9 is an example of a patient going on a cruise and is prescribed anti-nausea for motion sickness, as it is a preventive measure.

Any idea on whether or not there is a code out there for this scenario or are we stuck with no code?

TIA

 

[pscanlan]

Uhh, not to be too judgmental, but why is he providing antibiotics as a prophylactic? Antibiotics for simple diarrhea (and only potential diarrhea at that) or a potential cough seems to me like overkill. Practices like these are leading to a rise in antibiotic-resistant strains of bacteria, which makes genuine use cases for antibiotics less effective. I don't have the patient's medical record in front of me, so I can imagine that perhaps there could be a genuine reason to do so. But simply as a prophylactic - that's irresponsible. The anti-nausea meds might make more sense, although dramamine has commonly available OTC preparations, so again, this seems over-prescribed.

I think the reason you're having trouble coding this is because it's not good medicine to give out prescription drugs before people are sick.

Anyway, enough with the lecture. You've already found the best fit ICD-10 code, although in my opinion it's a bit of a stretch to call that first case prophylactic. You could also, if the patient has experienced such symptoms before, code for a personal history or sequela visit (eg. T75.3XXS). You said that the hunter had no previous respiratory issues, but motion sickness and "travellers diarrhea" are both recurrent sorts of illnesses. A history of either could justify prescribing something stronger than OTC meds.

 

[TThivierge]

Dx prescribing meds

Hello
If a patient is seeking meds for illness of course completed the ROS and HPI must be done, but the doctor needs to give their diagnosis related to the medications. I would add the definitive dx code AND the dx. Z76.00 encounter for arriving at your door due to seeking more medications.


I hope this information helps you!

Lady T

Hey there,

So I have a provider who, in two separate encounters, has prescribed a patient medication in case they become ill. The first was for a patient taking a hunting trip, who was prescribed an antibiotic if he were to present with respiratory issues (no previous history of, currently healthy). The other is for a patient traveling out of country who was prescribed something if he were to present with "travelers diarrhea" again no previous history. The only code I was able to come up with was Z29.9 Encounter for prophylactic measures, unspecified. The problem I find with this code is these medications are not preventive, they are "just in case" the patient gets sick. I feel Z29.9 is an example of a patient going on a cruise and is prescribed anti-nausea for motion sickness, as it is a preventive measure.

Any idea on whether or not there is a code out there for this scenario or are we stuck with no code?

TIA