Overdose Deaths are Increasing

CDC’s data shows the frightening record high of overdose deaths.

The Centers for Disease Control and Prevention’s (CDC) provisional data shows that drug overdose deaths hit a record high of 107,622 in 2021. This is an increase of 15 percent over the 2020 reported overdose deaths. The overdose deaths due to opioids (synthetic or manufactured) were 71,000. The deaths related to methamphetamines increased to 33,000. The deaths related to cocaine were just under 25,000 (note that many fatal overdoses include combinations of drugs, hence the overlap). This data is currently provisional, and may be updated in the future.

I thought that I would review the coding process for poisoning, based on the Official Coding and Reporting Guidelines for ICD-10-CM 2022, Section I.C.19.e. This portion of the guidelines says:

1. Do not code directly from the Table of Drugs. Always check the Tabular Volume for additional instructions.
   
2. Use as many codes as needed to describe all drugs involved.
   
3. Only report a code once if two involved drugs use the same code.
   
4. If two or more drugs or medicinal or biological substances are involved, code separately, unless a combination is available.
   
5. Drug toxicity includes an adverse effect, poisoning, and underdosing.
   
   • Adverse effect – code the manifestation first, followed by the code for adverse effect of the drug. The code is found under the column titled “Adverse Effect.”
     
   • Poisoning – overdose, wrong substance given or taken in error, wrong route of administration. Poisoning includes accidental, self-harm, assault, and undetermined. These types have separate columns in the code book. Additional codes may be assigned for the manifestations.
     
   • Underdosing – taking less of a medication than is prescribed. The non-compliance codes (Z91.12-, Z91.13-, Z91.14-), or complication of care codes, can be used with the underdosing code to indicate intent, if known. Underdosing cannot be assigned as a principal diagnosis or first listed code.

The Poisoning and Adverse Effect Codes are found in the code range of T36-T50 (Poisoning by, adverse effect of and underdosing of drugs, medicaments, and biological substances) and T51-T65 (Toxic effects of substances chiefly nonmedicinal as to source).

We can see that the coding of these cases impacts data that is publicly reported. Incorrect reporting will cause the data to be revised.

Resources:

ICD-10-CM, Table of Drugs, 2022

ICD-10-CM Official Coding and Reporting Guidelines, April 2022: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2022/