Poisonings vs. Adverse Reactions vs. Toxic Effects vs. Underdosing Definition
Poisoning: reaction to the improper use of a medication. This can include either:
Wrong Route of administration
Taken in combination of alcohol, illicit medication, or with over-the-counter medications that have not been approved by a provider.
Adverse Reaction: reaction when a substance is taken correctly as directed.
Toxic Effect: reaction or effect due to the exposure to a substance that is not a medication.
Underdosing: taking less of a medication, than a provider or manufacture’s instruction.
T36-T50 code groupings correlate to Poisoning, Adverse Effects & Underdoing. T51-T65 code groupings correlate to Toxic Effects
PDx will be poisoning code (T36-T50) with the manifestation(s) sequenced as a Secondary Diagnosis
Pt. presents with Acute Pulmonary edema due to accidental heroin overdose in a patient who is heroin dependent.
PDx: Poisoning by heroin, accidental (unintentional), initial encounter (T40.1X1A)
SDx: Acute pulmonary edema (J81.0) MCC
SDx: Opioid dependence (F11.20) CC
DRG: 917 Poisoning & toxic effects of drugs w MCC
PDx will be the manifestation, symptom, or adverse effect followed by the appropriate code for the adverse effect of the drug (T36-T50)
Pt. presents with Toxic Encephalopathy from Digoxin toxicity. Upon questioning the pt. admits to taking the medication as prescribed.
PDx: Toxic Encephalopathy (G92.9)
SDx: Adverse effect of cardiac-stimulant glycosides and drugs of similar action, initial encounter (T46.0X5A)
SDX: 093 Other disorders of Nervous System without CC/MCC
PDx will be the toxic effect code (T51-T65) with the manifestation(s) sequenced as a Secondary Diagnosis
Pt. presented with suicide attempt, drinking Drano. Admitted for erosive esophagitis with bleeding and blood pressure monitoring.
PDx: Toxic effects of corrosive alkalis and alkali-like substance, intentional self-harm, initial encounter (T54.3X2A)
SDx: Ulcer of esophagus with bleeding (K22.11) MCC
DRG: 917 Poisoning and Toxic Effects of Drugs with MCC
The PDx will be the manifestation, symptoms, or adverse effect, followed by the appropriate code for the adverse effect of the drug (T36-T50)
Pt. presented with HTN urgency after stopping all their antihypertensive medications on their own.
PDx: HTN Urgency (I160)
SDx: Underdosing of other antihypertensive drugs, initial encounter (T46.5X6A)
DRG: 305 Hypertension without MCC
Chronic conditions related to alcohol or drug abuse, or dependence are not classified as poisoning. The code for the chronic condition is sequenced first, followed by a code for the abuse or dependence. For example:
|K70.30 + F10.20
|Alcoholic cirrhosis of the liver; chronic alcohol dependence
|K70.10 + F10.20
|Alcoholic hepatitis; chronic alcohol dependence, episodic
|Drug-induced depressive state due to cocaine abuse
CDI Practice Considerations
Since sequencing and thus DRG assignment is determined by the circumstance of the event, always make sure the adverse reaction, poisoning, toxic effect, or underdosing is clearly documented along with the medication or other toxic substance and query, as necessary.
Overdoses are considered poisoning.
Drug Toxicity due to a medication is either an adverse effect or poisoning, NOT a toxic effect. Query if the documentation is not clear.
Common Manifestations to review and potentially query for:
Be aware of the reason, if known, for the underdosing. If related to financial hardship, this could map to Z91.190 Patient’s noncompliance with other medical treatment and regimen due to financial hardship, or Z91.A20 Caregivers intentional underdosing due to financial hardship, supporting capture of Social Determinants of Health code. Refer to Official Coding Guideline I.C.21.c.17 ‘Social Determinants of Health’ for additional guidance.
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