Poisoning as Treatment

When treating COVID-19, it is important to follow the guidance of medical professionals in using medications.

There has been much speculation about using hydroxychloroquine as a treatment for COVID-19. This drug is an immunosuppressant and anti-parasitic drug that is used to treat malaria. Another name for the drug is Plaquenil. Side effects include skin rashes, nausea, indigestion, diarrhea, headaches, mild hair loss, tinnitus, and visual problems. The adverse effect and poisoning codes for this drug include:

• Accidental – T37.8X1-
• Self-Harm – T37.8X2-
• Assault – T37.8X3-
• Poisoning, Undetermined – T37.8X4-
• Adverse Effect – T37.8X5-
• Underdosing – T37.8X6-

For accurate coding of poisonings and adverse effects, the coding guidance must be followed. The guidelines for poisoning include the following:

• Always confirm the code from the Table of Drugs and Chemicals with the Tabular.
• Use as many codes as necessary to completely capture the drugs involved.
• Only use the code once. If two drugs are classified to the same code, you only need to report it once.
• “Adverse effect” means that the patient was taking the medication as directed, but something untoward occurred. Assign the code(s) for manifestations, followed by the poisoning code.
• Poisoning occurs when drug is not used as prescribed. Intent is included in the code. Interaction between drugs and alcohol is classified as a poisoning. Manifestations of poisonings are assigned as additional codes.
  • Accidental – unintentionally taking too much of the medication. An example would be unintentionally taking a second dose.
  • Self-Harm – intentional misuse of medication with an example of trying to commit suicide.
  • Assault – another person intentionally causes the patient to use medication improperly. The example here is adding a medication to someone’s food or drink to intentionally hurt or kill them.
  • Undetermined – should only be used when the provider has documented that the intent is unknown, without any indicators of the patient’s intent.
• Underdosing – taking less of a medication than prescribed. The underdosing codes cannot be listed as a principal or first-listed diagnosis. Codes for non-compliance should also be assigned.

Accurate coding of poisonings and adverse effects include correct assignment of the seventh characters. There are three seventh characters that are associated with poisonings and adverse effects. The seventh character of “A” is used while the patient is undergoing active treatment and the condition is acute. The seventh character of “D” indicates that the visit is a subsequent encounter; the active phase has been completed and the patient is undergoing routine care during the healing phase. For aftercare of poisonings and adverse effects, assign the poisoning code with the seventh character of “D.” The seventh character of “S” is used to indicate that a residual condition remains after treatment has been completed. The residual condition should be listed first, followed by the poisoning code, with the seventh character of “S.”

As we think about various methods to treat COVID-19, it is important to follow the guidance of our medical professionals in using medications. Take medication as prescribed.

Programming Note: Listen to Laurie Johnson’s live reporting every Tuesday on Talk Ten Tuesday, 10-10:30 a.m. EST.

Resources: 

https://perspectives.ahima.org/health-information-management-best-practices-for-quality-health-data-during-the-covid-19-global-pandemic/

For all things related to COVID-19, you can use this URL:  https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page. This page contains coding advice, updates to regulations, and pricing information.