Anticholinergic response

katysuegood@gmail.comkatysuegood@gmail.com
in CDI Talk Archive
Shot in the dark here ;-).
I have patient who came in with SIRS with encephalopathy 2/2 an anticholinergic response to Benadryl. It seems the anticholinergic response should be Pdx but I can't seem to find an appropriate code.

Ideas?

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

Comments

  • annnd2009@gmail.comannnd2009@gmail.com
    edited April 2016
    I wonder if the encephalopathy would the the symptom of the adverse effect (PDX)and the sirs a seconday diagnosis...

    Ann
    On Jul 21, 2014, at 9:06 AM, CDI Talk wrote:

    Shot in the dark here ;-).
    I have patient who came in with SIRS with encephalopathy 2/2 an anticholinergic response to Benadryl. It seems the anticholinergic response should be Pdx but I can
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    This is what I have right now but I feel like I am missing something. Just wanted to make sure there isn't a better way.

    Thanks for your input Ann!

    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
  • annnd2009@gmail.comannnd2009@gmail.com
    edited April 2016
    I had a similar situation with shock due to a drug and it was driving me crazy that it went to anaphylaxis and not shock not related to trauma, though they were on pressors. A little different but I experienced the same emotions :)
    On Jul 21, 2014, at 9:18 AM, CDI Talk wrote:

    This is what I have right now but I feel like I am missing something. Just wanted to make sure there isn't
  • axel.olson@essentiahealth.orgaxel.olson@essentiahealth.org
    may want to second check but i believe the code for the reaction is:

    995.20 Unspecified adverse effect of unspecified drug, medicinal and biological substance

    then a second code for the med...

    if you use the 995.20 for PDX Then DRG is 918

    ...
    i would think to use this as PDX

    ... or maybe the SIRS
  • annnd2009@gmail.comannnd2009@gmail.com
    edited April 2016
    It's not an unspecified reaction though? Wouldn't it be the encephalopathy?
    When there is an adverse reaction to a drug the reaction comes first, when it's a poisoning the code for poisoning comes first followed by the reaction.

    And SIRS can't be first (i'm pretty sure)...

    Ann
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    Right now I have the Pdx as encephalopathy with a Sdx of SIRS and the E code E933.0 to account for the adverse effect.

    In the I-9 book there is a tip under 995.2 that states that these codes should not be used for inpatient admissions.

    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
  • axel.olson@essentiahealth.orgaxel.olson@essentiahealth.org
    Lol... yep..just saw the Faye Brown note on that...

    Im fairly new at this...

    ....what stops you from using SIRS as PDX?

    Axel Olson, RN, CDS
    Clinical Documentation Improvement
    Essentia Health
    Axel.Olson@essentiahealth.org
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    When coding SIRS, the underlying cause must be sequenced first.

    All these complexities :)

    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
  • axel.olson@essentiahealth.orgaxel.olson@essentiahealth.org
    Gotcha... right and in the codebook it even lists encephalopathy as an example...

    lol.. sorry.. I should look before I speak :)

    it seems like encephalopathy is the best choice..

    ... still seems like there should be a better code to describe your patients situation... sounds more serious than the rw that DRG represents.

    thanks for the lesson :)

    Axel Olson, RN, CDS
    Clinical Documentation Improvement
    Essentia Health
    Axel.Olson@essentiahealth.org
  • annnd2009@gmail.comannnd2009@gmail.com
    edited April 2016
    There is soooooo much to learn it's always good to ask here!!! I learn so much from people's responses no apologies needed ever!
    Ann

    I actually learned these points from making the same mistakes!
  • jolene.filejolene.file
    edited April 2016
    I think you are correct, Katy.

    Ref. C. Clinic- 1st Qrtr. 2010.- SIRS due to medication Code symptom & E-code for medication and 995.93 for the SIRS.

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

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