Poisoning sequencing

katysuegood@gmail.com

I have a case where a chronic alcoholic was admitted for treatment of a GI bleed. But also documented in the record is that he had 'probable isopropyl alcohol ingestion, presented with osmolal gap'. This was not the focus of case but will it be the Pdx in this instance because it is a 'poisoning'?

Thanks!

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

dtbanosb@yahoo.com

Hi Katy,

I'd think that since the GI Bleed is "the focus of the case" (greater resource utilization and present on admission), that would be the pDx, with the poisoning being a secondary dx, that also happened to be present on admission, unless the attending somehow "linked" the poisoning as a cause of the bleed.

Steve Banovich, RHIA, RN, CCS, CCDS

annnd2009@gmail.com

Just wondering... Would it matter if the etoh was with a drug to call
poisoning(like Asa)? And then would it be pdx?

Ann

Sent from my iPhone

dtbanosb@yahoo.com

Would depend whether the additional drug(s) (esp. ASA example) was documented as underlying cause of the bleed (ie: "cause after study")since both the poisoning and bleed have a p.o.a. = Y...

sb

jolene.file

Hi!
Not sure what the question was but there are chapter specific coding guidelines for (Obstetrics, poisoning, HIV, & newborn) that provide sequencing direction and take precedence. You might want to flip to the Poisoning by Drug, Medicinal & BIological Substance section (960-979) and read the the includes,excludes & TIP. Also provided some references if you hadn't seen them.

C.Clinic P.Dx. selection guidelines- 1990 - In determining principal diagnosis the coding directives in the ICD-9-CM manuals, Volumes I, Il, and III, take precedence over all other guidelines.

C.Clinic, 1990- Poisoning sequencing guideline -pg. 11.

Hope the above might be helpful in your decision.

Jolene File,RHIT,CCS,CPC-H,CCDS
Documentation Improvement Specialist-Coder
Hays Medical Center
jolene.file@haysmed.com

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