Poisoning rule

nursronnamnursronnam
in CDI Talk Archive
We are having a disagreement between CDS and Coder in regards to the poisoning rule.

Coder expects there to be documentation of "poisoning" or "OD" to code poisoning due to heroin.

CDS believes because the cardiac arrest was due to heroin ingestion.

Can anyone help shed light to this situation?

Documentation from chart

(H&P)
"female presenting with cardiac arrest. Patient was reportedly doing well, when she came home after doing Heroin with boyfriend, and was feeling short of breath. She had went to her room and was puffing Albuterol and started her nebulizer when she screamed for her mom to call EMS because she felt like she was going to die"

(Discharge summary)
DIAGNOSES AT TIME OF DEATH:
1. The patient had a hypoxic arrest likely secondary to an asthma reaction in the setting of heroin inhalation.
2. Pulseless electrical activity arrest, suspect secondary to hypoxia.
3. Hypoxic brain injury.
4. Probable aspiration pneumonia with methicillin-resistant Staphylococcus aureus positive sputum.
5. Drug abuse.
6. Probable sepsis present on admission in the setting of an aspiration pneumonia. The patient met SIRS criteria on admission and aspiration pneumonia was treated.
7. Acute hepatitis from shock liver.
8. Acute encephalopathy secondary to the brain injury mentioned.

Comments

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited March 2016
    Our coders would take this as a poisoning. There is no therapeutic/appropriate use for heroin (as opposed to alcohol), this has been their reasoning in the past. However this is not explicitly stated in the guidelines. There are (old, I-9) coding clinics to support this:



    Cocaine intoxication with chest pain

    Coding Clinic, First Quarter 1993 Page: 25 Effective with discharges: January 1, 1993

    Question:

    How does one code chest pain in a patient who took cocaine a few hours before. The physician stated that this chest pain was due to the cocaine intoxication. Would the principal diagnosis be the cocaine intoxication or chest pain?

    Answer:

    Note from 3M :

    As of October 1, 2010, code 970.8 has been expanded and a unique code (970.81) has been created to identify cocaine poisoning.

    Note from 3M :

    As of October 1, 2002 the coding of cocaine/crack overdose has been changed to 970.8

    This is a poisoning, not an adverse effect of correct substance taken correctly. Therefore, code 968.5, Poisoning by other central nervous system depressants and anesthetics, Surface [topical] and infiltration anesthetics, would be the principal diagnosis. Assign code 305.60, Nondependent abuse of drugs, Cocaine abuse, unspecified, and code 786.50, Chest pain, unspecified, as additional diagnoses.


    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

  • Unknown
    edited March 2016
    All illegal drugs are poisonings. Period. See back to Coding Clinics ICD-9 4Q 2010 and many others for guidance as well as Official Guidelines for ICD-10 1,C,e and below.

    Robert S. Gold, MD
    CEO, DCBA, Inc
    4611 Brierwood Place
    Atlanta, GA 30360
    (770) 216-9691 (Office)
    (404) 580-0204 (Cell)

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    This is a poisoning. Heroin was used in a ‘noncompliant’ manner, and per the chart: The patient had a hypoxic arrest likely secondary to an asthma reaction in the setting of heroin inhalation





    [cid:image002.png@01D12B4C.D0C14150]

    ‘





    [cid:image001.png@01D12B4C.B0CA1E80]





    Paul Evans, RHIA, CCS, CCS-P, CCDS



    Manager, Regional Clinical Documentation & Coding Integrity

    Sutter West Bay

    633 Folsom St., 7th Floor, Office 7-044

    San Francisco, CA 94107

    Cell: 415.412.9421



    evanspx@sutterhealth.org







Sign In or Register to comment.