Beth Ford, RHIT, CCS, Clinical/Technical Editor
The 2012 ICD-10-CM Draft Official Guidelines for Coding and Reporting contains updated advice for coding and reporting drug-induced (adverse-effect) conditions that aligns coding practice with ICD-9-CM.
Formerly, draft ICD-10-CM coding guidelines instructed coders to assign the drug toxicity code first, followed by the manifestation code for the specific adverse effect. In ICD-9-CM, the reverse is true: the adverse effect is sequenced first, followed by the appropriate external cause code (E code).
Narrative changes to the ICD-10-CM Draft Official Guidelines for Coding and Reporting appear in bold text. Note the following changes to 2012 draft ICD-10-CM coding guideline 1.C.19.e.5.a.:
ICD-10-CM 2011 Draft Official Coding Guidelines, Section I.C.19.e.5.a:
(a) Adverse Effect
Assign the appropriate code for the adverse effect (For example T36.0X5-) when the drug was correctly prescribed and properly administered. Use additional code(s) for all manifestations of adverse effects. Examples of manifestations are tachycardia, delirium, gastrointestinal hemorrhaging, vomiting, hypokalemia, hepatitis renal failure or respiratory failure.
ICD-10-CM 2012 Draft Official Coding Guidelines, Section I.C.19.e.5.a:
(a) Adverse Effect
When coding an adverse effect of a drug that has been correctly prescribed and administered, assign the appropriate code for the nature of the adverse effect followed by the appropriate code for the adverse effect of the drug (T36-T50). The code for the drug should have a 5th or 6th character”5” (for example T36.0X5-). Examples of the nature of an adverse effect are tachycardia, delirium, gastrointestinal hemorrhaging, vomiting, hypokalemia, hepatitis renal failure or respiratory failure.
The updated guidelines provide additional information regarding assignment of appropriate fifth or sixth characters that indicate an adverse effect circumstance or intent. Seventh-character extensions are required to report the encounter status as initial, subsequent, or sequela. The fifth or sixth character differentiates adverse effects of drugs from poisonings, suicide attempts, assaults, underdosing, and unknown circumstances. In ICD-10-CM, code expansion includes classification of the intent in the drug toxicity code (T code). Unlike ICD-9-CM, no external cause code is required. For example:
The appropriate seventh character is to be added to each code from category T36.
A initial encounter
B subsequent encounter
T36.0X Poisoning by adverse effect of and underdosing of penicillins
T36.0X1 Poisoning by penicillins, accidental (unintentional)
T36.0X2 Poisoning by penicillins, intentional self-harm
T36.0X3 Poisoning by penicillins, assault
T36.0X4 Poisoning by penicillins, undetermined
T36.0X5 Adverse effect of penicillins
T36.0X6 Underdosing of penicillins
The resequencing of drug toxicity and adverse effect codes brings ICD-10-CM coding more into line with ICD-9-CM guidelines, promoting the continuity of coding and reporting. The use of combination codes in ICD-10-CM increases the possibilities for capturing specific data. The sequencing revision, combined with code expansion in ICD-10-CM, promotes data integrity between the two classification systems, while increasing the ability to report specific data in ICD-10-CM.
The 2012 ICD-10-CM Draft Official Guidelines for Coding and Reporting are posted by the National Center for Healthcare Statistics (NCHS) on the Centers for Disease Control (CDC) website at http://www.cdc.gov/nchs/icd/icd10cm.htm.