Polypharmacy

katysuegood@gmail.comkatysuegood@gmail.com
in CDI Talk Archive
Hello everyone, I could use some help on a death chart.

Case scenario:
Elderly patient on multiple psych meds presents with encephalopathy, Query specifies toxic possibly related to medication. They are suspicious of infection though they have no source. They treat empirically with multiple abx including coverage for meningitis because they are suspicious of encephalitis but they are unable to do an LP due to agitation. They also are concerned about polypharmacy because of his mult psych meds though there has been no recent change in his Rx. His tox screen is positive for methadone but they cannot find an RX for it. Very short LOS and short workup because he has a cardiac arrest on day two and is an DNR.
We have polypharmacy documented many times but no stated overdose and the question of the methadone Rx is unresolved.

In this case would you code this polypharmacy as an adverse effect or poisoning? What are your reasons?

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

Comments

  • catladyrncatladyrn
    Based on what you state, I would code it as an adverse effect. Nothing in your scenario suggests anything that would fall under poisoning. In the absence of any black box warnings about drug interactions for the medications prescribed, the presumption must be made that all the medications were prescribed correctly and given correctly, as far as you have described. I don't know about the methadone, as the patient may also have been taking that legitimately, but even had he not, would the presence of methadone have resulted in the clinical presentation?

    Renee

    Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
    Director, Clinical Documentation, Core Measures and Outcomes
    Tanner Health System
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    I agree Renee, that is what I am advocating for however the coder is telling me it codes to toxicity.
    She says " When a serious condition requiring treatment is caused by a drug or drugs that are high risk such as these due to a “cross reaction” (so stated) between said drugs it is a toxicity which still codes to poisoning." She references the following chain: "You enter encephalopathy>>choose “spell cause”>>type in “drugs”>>reaction screen “circumstance unspecified” because they are not specified>>type drug name and place of occurrence and you get a pile of 900 codes one for each type of drug he was taking and they are poisoning codes so they have to go first per guidelines not the encephalopathy."

    I respect this coder however I have yet to find a reference that points to coding polypharmacy as toxicity. Just trying to figure out how hard to push on this one ;-)

    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

  • catladyrncatladyrn
    I am not sure why she is taking the option of "circumstances specified as undetermined," which is the only way she can get it over to poisoning in the absence of overdose or error in prescription. Did they actually say the circumstances were undetermined? The circumstance is that he was prescribed these medications, they were administered, and he may not have tolerated the combination, which is an adverse drug effect. I think she's making a lot of assumptions that are not there. It's not even clear from the scenario that his medications necessarily were responsible for why he presented, arrested, and died.

    Renee

    Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
    Director, Clinical Documentation, Core Measures and Outcomes
    Tanner Health System
  • ssalinasssalinas
    edited April 2016
    If the coder is choosing "circumstance unspecified", then it goes to adverse effect.

    In regards to toxicity and adverse effects, CC 3rd Qtr 1995 page 13 states "If the medication was correctly prescribed and administered, this should be coded as an adverse effect with the code for the reaction assigned as the principal diagnosis followed by the appropriate E code from category E930-E949"

    Don't know if this is good enough reference, but it seems pretty clear to me.... What is her source? And I really think she is choosing the incorrect 'specific reaction to drug' by choosing "specified as undetermined".

    Sharon Salinas, CCS
    Health Information Management
    Barlow Respiratory Hospital
    2000 Stadium Way, Los Angeles CA 90026
    Tel: 213-250-4200 ext 3336
    FAX: 213-202-6490
    ssalinas@barlow2000.org


Sign In or Register to comment.