Poisoning and adverse effect of drugs

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Adverse condition

caused by a correctly prescribed and used drug

Poisoning

caused by the incorrect use of a drug or other substance

Code poisoning first

manifestation 2nd

Interactions of properly used therapeutic drugs and alcohol or nonprescription drugs

are considered instances of poisoning

Acute conditions caused by alcohol or drug abuse

are considered poisonings
Chronic conditions are not

Prescribed medication not used as frequently as prescribed or in smaller amounts

is not a poisoning

Drug administered properly

Adverse effect is sequenced first
E code E930-E949

Interaction of two or more drugs, correctly used

Adverse effect
E code for each drug

Toxic effects

Harmful substances ingested or coming in contact with a person.

Example
Chronic manganese toxicity

985.2 Toxic effect of manganese and its compounds
E866.5 Accidental poisoning by other and unspecified solid and liquid substances, plant foods and fertilizers

Example
Toxicity due to exposure to arsenical pestcide

985.1Toxic effect of arsenic and its compounds
E863.4 Accidental poisoning by agricultural and horticultural chemical and pharmaceutical preparations other than plant foods and fertilizers.Other and unspecified insecticides

Toxicity due to asbestos exposure

989.81 Toxic effect of other substances, chiefly nonmedicinal as to source, Asbestos
E866.8 Accidental poisoning by other and unspecified solid and liquid substances, other specified solid or liquid substances

Toxic effects

sequenced first
then results of the toxic effect

Toxic effects
External cause to indicate intent

E860-E869accidental exposure
E950.6 or E950.7intentional self-harm
E962 assault
E980-E9872 undetermined

Digitalis or Lithium

Toxic effects usually refer to an adverse effect of a correctly administered prescription drug

Terms that identify adverse effect

Allergic reaction
Cumulative effect of drug (toxicity)
Hypersensitivity to drug
Idiosnycratic reaction
Paradoxical reaction
Synergistic reaction

Terms that identify poisoning

Wrong medication given or taken
Error made in drug prescription
Wrong dosage given or taken
Intentional drug overdose
Nonprescribed drug taken with correctly prescribed and properly administered drug

Poisoning sequenced first

manifestation 2nd

960-979

Poisoning due to drugs and medicinal and biological substances.

965.6
965.61

identify antirheumatics drugs that are propionic acid derivatives

965.69

other antirheumatics drugs

result of interaction of a therapeutic drug used correctly with a nonprescritpion drug or with alcohol, i

poisoning

Example
coma identified as an adverse reaction to Valium taken correctly but associated with the intake of two martinis is coded

908.0 Poisoning due to alcohol
969.4 Poisoning due to Valium
780.01 coma
E860.0 Accidental poisoning by ethyl alcohol
E853.2 Accidental poisoning by benzodiazepine tranquilizers

AHFS

American Hospital Formulary Service
Look up drugs not in the ICD9CM index of drugs and chemicals

ICD9CM poisoning codes also listed

appendix of vol 1

Example
Suprventricular premature beats secondary to use of digitalis and Valium, both used as prescribed

427.61 Premature beats
E942.1 Cardiotonic glycosides and drugs of similar action
E939.4 Benzodiazepine-based tranquillizers

Example
infant with a high fever due to correct administration of DPT vaccine

780.63 postvaccination fever
E948.6 Pertussis vaccine including combinations with a pertussis component

Example
patient suffering from dry mouth and itching as a result of taking phenobarbital as prescribed by his physician

527.7 Disturbance of salivary secretion
698.9 Unspecified pruritic disorder
E937.0 Barbiturates

When external cause not stated

assign code for poisoning undetermined
E980--E982

Example
Coma due to accidental poisoning due to codeine

965.09 Opiates and related narcotics, other
780.01 Coma
E850.2 Other opiate and related narcotics

Example
Coma due to codeine taken in a suicide attempt

965.09 Opiates and related narcotics, other
780.01Coma
E950.0 Suicide and self-inflicted poisoning by solid or liquid substances

Example
Coma due to overdose of codeine, cause unknow

965.09 Opiates and related narcotics, other
780.01 Coma
E980.0 Poisoning by solid or liquid substances, undetermined whether accidentally or purposely inflicted

If reporting format limits the number of E codes

use the one most closely related to the principal diagnosis

If different E codes are needed in he same 3-digit category

use "other" specified in that category or unspecified code

If E codes are from different 3-digit categories

assign # code for other multiple drugs and medicinal substances.

Example
poisoning that resulted from ingestion of aspirin, phenobarbital and antihistamines taken in a suicide attempt, would require 3 E codes in 3 different categories

E950.4 Suicide and self-inflicted poisoning by other specified drugs and medicinal substances
Assign for limited reporting space

Environmental Toxins
Example
patient developed sever abdominal pain, vomiting and a tingling sensation in the fingers after eating shellfish. The patient was diagnosed with neurotoxic shellfish poisoning due to red tides

988.0 Toxic effect of noxious substances eaten as food, fish and shellfish
E928.6 Environmental exposure to harmful algae and toxins
V87.32 Contact with and (suspected ) exposure to algae bloom
Red tide-- brevetoxin
Karennia brevis (k.brevis)

995.2
Outpatient setting only

Other and unspecified adverse effect of drug, medicinal and biological substance

796.0
If adverse conditions cannot be identified

Nonspecific abnormal toxicological findings
Heavy metals and drugs in blood urine or other tissue
E930-E949 assigned as well

995.20

Unspecified adverse effect of unspecified drug, medicinal and biological substance

995.21

Arthus phenomenon

995.22

Unspecified adverse effect of anesthesia

995.23

Unspecified adverse effect of insulin

995.27

Other allergy drug

995.29

Unspecified adverse effect of other drug, medicinal and biological substance

Alcohol + drugs

Assign codes for:
poisening
manifestation of the poisoning
dependence or abuse
E code for circumstances

Alcoholic cirrhosis of the liver; chronic alcohol dependence

572.2 Alcoholic cirrhosis of liver
303.90 Other and unspecified alcohol dependence

Alcoholic hepatitis; chronic alcohol dependence, episodic

571.1 Acute alcoholic hepatitis
303.90 Other and unspecified alcohol dependence

Drug-induced depressive state due to cocaine abuse

292.84 Drug-induced mood disorder
305.60 Cocaine abuse

Acute pulmonary edema due to accidental heroin overdose in a patient who is heroin dependent

965.01 Poisoning by analgesics, antipyretics, and antirheumatics, Heroin
518.4 Acute edema of lung, unspecified
304.00 Opioid type dependence
E850.0 Accidental poisoning by analgesics, antipyretics, and antirheumatics, Heroin

Late effects of adverse reaction to drugs

code late effect1st
909.1 Late effect of toxic effects of nonmedicinal substance
E929.2 late effects of poisoning

Brain damage due to allergic reaction to penicillin (current medication)

348.9 Other conditions of brain,Unspecified condition of brain
E930.0 DRUGS, MEDICINAL AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE (E930-E949) Antibiotics Penicillins

Brain damage due to allergic reaction to penicillen (use of medication discontinued six months ago)

348.9 Other conditions of brain,Unspecified condition of brain
909.5 Late effect of adverse effect of drug, medicinal or biological substance
E930.0 Antibiotics

Steroid-induced diabetes in a patient currently taking steroids as prescribed is coded as an adverse effect

249.00 Secondary diabetes mellitus without mention of complication
E932.0 DRUGS, MEDICINAL AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE Adrenal cortical steroids

Long-term chronic effects of a prescription drug taken over a period of time and still being taken at the time the chronic effects arise --

are coded as current adverse effects

Late effect of poisoning

residual condition
909.0 Late effect of poisoning due to drug, medicinal or biological substance
E929.2 Late effects of accidental poisoning

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