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Poisoning and adverse effect of drugs

STUDY
PLAY
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