1 / 37

Basic ICD-10-CM/PCS Coding 2013 Edition

Basic ICD-10-CM/PCS Coding 2013 Edition. Chapter 22B: Poisoning and Certain Other Consequences of External Causes (T36–T88). Learning Objectives. Review the chapter’s learning objectives and key terms

tpennington
Download Presentation

Basic ICD-10-CM/PCS Coding 2013 Edition

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Basic ICD-10-CM/PCS Coding2013 Edition Chapter 22B: Poisoning and Certain Other Consequences of External Causes (T36–T88)

  2. Learning Objectives • Review the chapter’s learning objectives and key terms • Poisonings, adverse effects, and certain other consequences of external causes are described in this chapter with specific definitions and rules for coding • At the conclusion of this chapter, what must you know about the coding of these conditions?

  3. ICD-10-CM Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00–T88) Codes in ICD-9-CM categories T36–T50 are combination codes. The codes identify whether the condition was a(n): Poisoning Adverse effect Underdosing of drug or biological substance Also included in the code is the external cause

  4. ICD-10-CM Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00–T88) In ICD-10-CM under a single category for a specific drug, there is one code for each drug to identify poisoning, adverse effects and underdosing by the drug. The sixth character identifies the condition (poisoning, adverse effect underdosing) from the use of the code

  5. ICD-10-CM Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00–T88) The poisoning codes include the intent of the poisoning, if known, such as accidental, intentional self harm or assault as well as a code for undetermined when the facts are not known

  6. ICD-10-CM Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00–T88) Underdosing is new terminology in ICD-10-CM It is defined as taking less of a medication than is prescribed by a provider or the manufacturer’s instructions with a resulting negative health consequence As a consequence, the patient suffers a negative health consequence, such as a worsening of the condition intended to be treated by the medication

  7. Coding Instructional Notes for ICD-10-CM Chapter 19 At the start of the chapter is a note “Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause code.”

  8. Coding Instructional Notes for ICD-10-CM Chapter 19 Under T36–T50 is an “Includes” note to state: Adverse effect of correct substance properly administered Poisoning by overdose of substance Poisoning by wrong substance given or taken in error Underdosing by (inadvertently)(deliberately) taking less substance than prescribed or instructed

  9. Coding Instructional Notes for ICD-10-CM Chapter 19 Under T36–T50, there are other instructions to: Code first, for adverse effects, the nature of the adverse effect, such as: Adverse effect NOS (T88.7) Aspirin gastritis (K29-) Blood disorders (D56-D76) Contact dermatitis (L23-L25) Dermatitis due to substance taken internally (L27-) Nephropathy (N14.0-N14.2)

  10. Coding Instructional Notes for ICD-10-CM Chapter 19 Under T36–T50, there are other instructions to: Note:The drug giving rise to the adverse effect should be identified by use of codes from categories T36–T50 with fifth or sixth character 5 Use additional code(s) to specify: Manifestations of poisoning Underdosing or failure in dosage during medical and surgical care (Y63.6, Y63.8–Y63.9) Underdosing of medication regimen (Z91.12-, Z91.13-) Use additional code (Y62–Y82) to identify devices involved and details of circumstances

  11. Coding Guidelines for ICD-10-CM Chapter 19 ICD-10-CM chapter specific guidelines exist Codes in categories T36–T65 are combination codes that include the substances related to adverse effects, poisonings, toxic effects, and underdosing, as well as the external cause Do not code directly from the Table of Drugs Use as many codes as necessary to describe Assign the code only once even if the causative agent describes more than one adverse reaction, poisoning, toxic effect or underdosing

  12. Coding Guidelines for ICD-10-CM Chapter 19 ICD-10-CM chapter specific guidelines (continued) Codes in categories T36–T65 are combination codes that include the substances related to adverse effects, poisonings, toxic effects, and underdosing, as well as the external cause Code each drug individually if two or more drugs are involved Occurrence of drug toxicity rules for adverse effect, poisoning, underdosing and toxic effects Adult and child abuse, neglect and other maltreatment

  13. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 The Alphabetic Index provides direction for coding Main term of “adverse effect,” “poisoning,” or “poisoning, drug,” and “underdosing,” in the Index directs the code to see also the Table of Drugs and Chemicals Table of Drugs and Chemicals follows the ICD-10-CM Neoplasm Table that appears after the ICD-10-CM Index to Diseases and Injuries

  14. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 Table of Drugs and Chemicals is organized into seven columns with rows for the substances involved First, left-most column contains the name of the drug, chemical, or biological substance Next six columns contain codes for Poisoning, accidental (nonintentional) Poisoning, intentional self-harm Poisoning, assault Poisoning, undetermined Adverse effect Underdosing

  15. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 No every row has a code in the each of the six columns Certain chemicals cannot produce an adverse effect or underdosing because the substance is not used for therapeutic purposes Codes are in the range of T36–T50 Combination codes include the substance taken by the patient, appropriately or inappropriately, and describe the intent as well There is no need to use an additional external cause of morbidity code as the external cause or intent is included in T36–T50 codes

  16. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 Adverse effect can occur when a medication is prescribed correctly and administered properly The patient does everything right—right drug, right dose, right route of administration—but a physical reaction is experienced Common causes of adverse effects are: Cumulative effects Hypersensitivity or allergic reaction Synergistic reaction Interaction with another medication Side effects

  17. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 Instructions for coding adverse effects: Code first the manifestation or the nature of the adverse effect, such as urticaria, vertigo, gastritis and so forth Locate the row for the drug responsible in the “substance” in the Table of Drugs and Chemicals and select the code in the sixth column under the column heading of adverse effect Assign the appropriate seventh character to identify whether the healthcare was provided during the initial encounter, a subsequent encounter, for a sequela If more than one drug or chemical is involved, use as many codes as necessary form the Table of Drugs and Chemicals to completely describe all the drugs and chemicals involved

  18. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 Instructions for coding adverse effects: If the same drug produced more than one manifestation or adverse effect, assign the drug code only once If two or more drugs or chemicals are involved, each drug or chemical should be coded separately unless there is a combination code If the patient has a current condition that is the late effect or sequela of an adverse effect of a correct substance properly administered: First code the residual or late effect, such as blindness or deafness Assign the code for the drug that produced the adverse effect with the seventh character of S for sequela See Figure 22B.1

  19. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 Poisoning refers to conditions caused by drugs, medicinal substances, and other biological substances only when the substance involved is not used according to the physician’s instructions Poisoning occurs when something is done wrong—wrong drug, wrong dose, wrong route of administration, wrong person receiving the drug or the drug should not have been used Poisoning occurs with prescription drugs, over-the-counter purchased medications, illegal drugs or when drugs are taken with alcohol beverages

  20. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 Poisonings can occur when When there is an error in the drug prescription An overdose of a drug is intentionally taken A nonprescribed drug is taken with a correctly prescribed and properly administered drug and a drug toxicity or other reaction occurs as a result of the interaction of these two drugs A drug is taken with alcohol and produces a medical condition or reaction due to the interaction of the drug(s) with alcohol

  21. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 Instructions for coding poisonings: Use the Table of Drugs and Chemicals to locate the drug or other agent Code first the code from the poisoning column depending on the associate intent with the fifth or sixth character identifying it as accidental, intentional self-harm, assault and undetermined Next code all the specified manifestation or effects of the poisoning, such as coma, vertigo, drowsiness or other condition If there is also a diagnosis of drug abuse or dependence to the drug, it is coded as an additional diagnosis If the patient has a current condition that is the late effect or sequela of an adverse effect of a poisoning or overdose, it is coded as First code the residual condition or late effect, such as organ or nerve damage Assign the code for the drug that produced the poisoning with the seventh character of S for sequela See Table 22B.2

  22. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 Underdosing is when a patient takes less of a medication than is prescribed by the provider or a manufacturer’s instruction The code from T36–T50 for the drug is assigned with the fifth or sixth character of 6 The code for underdosing is never listed first or as principal diagnosis If the patient has worsening of the medical condition that is being treated by the drug, the medical condition is coded first Noncompliance codes (Z91.12- or Z91.13-) or complication of care (Y63.8, Y63.8–Y63.9) codes are used with the underdosing code to indicate the intent if known

  23. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 A toxic effect occurs when a patient comes in contact with or ingests accidentally or otherwise a harmful substance The toxic effect code is included in categories T51–T65 The code includes the associated intent of accidental, intentional self-harm, assault or undetermined A note appears that a code for accidental intent should be used if no intent is indicated. The undetermined intent is only for use when there is specific documentation that the intent of the toxic effect cannot be determined

  24. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 Other and unspecified effects of external cause (T66–T78) This block of codes represent injuries and conditions that are caused by an external agent, such as radiation, heat, light, cold, air and wate pressure as an example The codes require the use of the appropriate seventh character to identify the episode of care, that is, initial encounter (A), subsequent encounter (D), or if the even represents a sequela (S)

  25. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 Asphyxiation (T71) Codes for asphyxiation could be documented by the provider as a traumatic or mechanical suffocation Combination codes exist to identify the state of asphyxiation as well as the cause for it, such as, smothering under a pillow, a plastic bag placed over the head, being trapped in bed linens, accidental or intentional hanging or trapped in a location Codes require a seventh character to identify the episode of care as initial, subsequent or as a sequela

  26. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 Adult and child abuse, neglect and other maltreatment, confirmed (T74) and suspected (T76) A code from T74 or T76 is assigned as the principal or first-listed code Any injury or mental health condition that occurs as a result of the abuse, neglect or other maltreatment is coded as an additional diagnosis If the provider documents the condition as abuse or neglect, it is coded as confirmed If the provider documents the abuse or neglect is suspected, it is coded s suspected A perpetrator code from category Y07 is added when the perpetrator of the abuse or neglect is known. It is not coded if abuse or neglect is suspected.

  27. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 Complications of surgical and medical care, not elsewhere classified (T80–T88) Codes for intraoperative and postprocedural complications and disorders are provided in specific body systems in ICD-10-CM Specific conditions identified in this block of codes represent all types of conditions that are unwanted but may not be entirely unavoidable in medical care

  28. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 The assignment of a complication code must be based on the provider’s documentation and the fact that the provider has made a connection between the condition and the medical care and procedure that apparently caused it. The provider must indicate the condition is a complication and was caused by the care provided The coder should query the physician for this relationship if the documentation is not specific as to the cause of the condition that a patient exhibits after medical care or a procedure

  29. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 Some of the complication codes have the external cause as well as the condition included in the code. No external cause code is required when the code includes the nature of the complication as well as the type of procedure that caused the complication Codes in the range of T80–T88 identify complications of surgical and medical care that are not specific to a particular body system A seventh character is required to identify if the condition was treated in an initial or subsequent encounter or represents a sequela

  30. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 Under the range of codes T80–T88, three directional notes appear: Use additional code for adverse effect, if applicable, to identify drug (T36–T50) with fifth or sixth character of 5. Use additional code(s) to identify the specified condition resulting from the complication Use additional code to identify devices involved and details of circumstances (Y62–Y83)

  31. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 Complications of procedures, not elsewhere classified (T81) Codes describe postprocedural shock, disruption of operative or surgical wound, infection following a procedure, complication of a foreign body accidentally left in the body following a procedures, acute reaction to foreign substance accidentally left during a procedure and not elsewhere classified vascular complication Directional notes state to use additional code for an adverse effect, use additional code to identify the infection by type or organism as well as additional code if severe sepsis is present

  32. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 Complications of prosthetic devices, implant and grafts (T82–T85) with specific codes that include: Mechanical complications such as breakdown, displacement, leakage or other mechanical complication of the device, implant or graft An infection or inflammatory reaction to a specific device with an additional code to identify the infection if the documentation provided Other specified complications such as embolism, fibrosis, hemorrhage, pain, stenosis, thrombosis or other specified conditions due to device, implant or graft Cardiac/vascular device (T82), genitourinary (T83), orthopedic (T84), and other body system devices (T85) Require seventh character for initial or subsequent encounter or sequela

  33. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 Complications of transplanted organs and tissues (T86) Use additional code to identify other complications such as graft-versus-host disease, malignancy associated with organ transplant or post-transplant lymphoproliferative disorders Kidney transplant patients may still have some form of chronic kidney disease and is not usually a complication of transplant Specific codes exist for transplant rejection, failure, infection for various types of organs and tissues that have been transplanted, for example, bone marrow, heart, lung, liver, skin, bone, corneal, intestine and other tissue

  34. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 Complications peculiar to reattachment and amputation (T87) Specific codes identify when there are complications related to a reattached (part of the) upper extremity, lower extremity or other body part specified as right, left, or unspecified side Other codes identify when there is a complication of an amputation stump and other and unspecified complication

  35. Coding Poisoning, Adverse Effects, Underdosing and Certain Consequences of External Causes in ICD-10-CM Chapter 19 Other complications of surgical and medical care, not elsewhere classified (T88) Category contains less frequently occurring complications Codes related to complications of anesthesia require an additional code for the drug responsible for an adverse effect if it was applicable Codes for anaphylactic reaction or shock require an additional code for the drug responsible When a specific adverse effect of a drug cannot be identified, a subcategory code T88.7xx with 7th character is used

  36. ICD-10-PCS Procedure Code for Poisoning and Certain Consequences of External Causes Any of the 31 root operations could be the objective of a procedure for conditions in chapter 19, for example, Dilation Extirpation Insertion Replacement Removal Revision Transplantation

  37. Exercises Practice coding the conditions included in Chapter 19 of ICD-10-CM for poisoning and certain other consequences of external causes, as well as the procedures used to treat these conditions by completing the review exercises for Chapter 22B.

More Related