Archive for October, 2018

Breaking It Down: Understanding the Classification of Drug Toxicity

Posted by Samantha Serfass on October 16, 2018 in Blog, News

Breaking It Down:

Understanding the Classification of Drug Toxicity


It is no surprise as to why many coders are having a problem coding poisoning, adverse effects and under-dosing. There are multiple guidelines to apply when considering the code choices in this category thus making the coding more complicated.   Physicians do not always document the terms poisoning, overdose, adverse effect or under-dosing.

This means the coders really need to understand how to apply the guidelines to the documentation in the record. Intent has to be determined in order to apply the correct overdose code and the correct status code for under-dosing.  To add further confusion, the manifestations are coded along with the poisoning code which contradicts the basic coding guidelines on symptoms.  Finally, sequencing guidelines are not consistent and are based on the type of drug toxicity code being assigned.

In order to simplify the process, there are four main elements to think about when making a decision on how to code in this category.

A poisoning is taking too much of a medication or not administrating the medication by the correct route, whether it was prescribed, over the counter or as a result of substance abuse.  This may be either intentional or accidental   Also falling into the poisoning category is taking prescription medication that was not prescribed with a current prescribed drug or mixing current medications with alcohol.  When sequencing, the poisoning codes are sequenced first followed by any manifestations.

  • An individual poisoning code is assigned for all drugs involved.
  •  Acute conditions as a result of drug and alcohol abuse are also included in this category.

Poisoning intent is the intention of why the poisoning occurred and this is built into the poisoning code as the 5th or 6th character.  Categories include accidental, assault, suicide, and undetermined.  If there is no documentation of the intent in the record the default is accidental.  Undetermined should only be used if documentation in the record states the intent of the poisoning cannot be determined.

An adverse effect is an acute symptoms or condition that occurs as a result of taking medication as prescribed and properly administered.  The manifestations are sequenced first followed by the adverse effect drug code.  Intention is not considered for adverse effects since the drug is taken as prescribed.

Under dosing is taking less of a medication than prescribed or not taking the prescribed medication at all.  This may result in an exacerbation of the condition that the drug was prescribed to treat.  The manifestation is sequenced first followed by the Under-dosing drug code.

Under-dosing Intent: Is the intention of why the drug was not taken as prescribed.  This is a status code that is not built into the under-dosing code. Categories are intentional, intentional due to financial hardship, unintentional, and unintentional due to the patient’s age related debility

A manifestation is an acute symptom, condition, or exacerbation of a chronic condition as a result of not taking medications as prescribed, taking medication as prescribed, or as a result of drug abuse. Note that manifestations are coded in all drug toxicity categories.


Case 1

Patient presents with syncope and states he had a couple of beers soon after taking his Metoprolol as prescribed.

  • T44.7X1A Poisoning by beta-adrenoreceptor antagonists, accidental, initial encounter.
  • T51.0X1A Toxic effect of ethanol, accidental, initial encounter
  • R55   Syncope

Rationale: This is a poisoning. Although medication was taken as prescribed, the medication was taken with alcohol resulting in the acute condition of syncope.  The poisoning codes for both the medication and alcohol are sequenced first. The intent was accidental and is built into the poisoning code. The manifestation of syncope is coded last

Case 2

Patient presents with headache and dizziness. He was just started on Metoprolol for his blood pressure and has been taking this as prescribed.

  • G44.40      Drug induced headache, NEC, not intractable
  • R42             R42 Dizziness and giddiness
  • T44.7X5A   Adverse effect of beta-adrenoreceptor antagonist, initial encounter.

Rationale: This is an adverse effect.  The medication was taken exactly as prescribed.   The manifestations are the acute conditions of headache and dizziness. The manifestations are sequenced first, followed by the adverse effect drug code.

Case 3

Patient presents in hypertensive crisis. After questioning, it was found that he was only taking his blood pressure medicine a couple times a week due to the price.

  • I16.9   Hypertensive crisis, unspec
  • T44.7X6A (Underdosing of beta-adrenoreceptor antagonists, initial encounter
  • Z91.120 Patient’s intentional under-dosing of medication regimen due to financial hardship

Rationale:  This is an under-dosing.  The patient was taking less than the prescribed medication. The manifestation is the hypertensive crisis. The intent is intentional due to financial hardship.  In this case, the manifestation of hypertensive crisis is sequenced first, followed by the under-dosing drug code.  The intent is not built into the under-dosing code and is sequenced last as a status code.


Mary J. Wood, RHIT, CCS. AHIMA Approved ICD-10-CM/PCS Trainer

Internal Auditor/Educator

Strategic Planning – Healthcare IT Infrastructure

Posted by Samantha Serfass on October 2, 2018 in Blog, News

Strategic Planning- Healthcare IT Infrastructure 


As the Healthcare Information Technology industry continues to quickly change, it has become important for CIOs and healthcare leaders to understand the financial side of upgrading and investing in new technologies, tools and solutions. They also need to have solid understanding of how best these solutions will help drive organizational business goals and outcomes with minimal risk, primarily around the improvement of patient care and increased revenue.

Business strategic planning and IT strategic planning need to evolve to develop a collaborative and functional strategy to deliver a clear path and direction. Healthcare IT must align with and consider key business goals and initiatives, then develop an all-inclusive strategy to provide flexible solutions that support those goals and initiatives. As healthcare organizations face the challenge of keeping up with and investing in the latest technology and tools, it’s important that all disciplines be included in strategy sessions and provide input in developing planning documentation.

Bringing qualified subject matter experts to the table will gain buy-in, improve performance, increase productivity and ultimately influence the culture. The plan should allow room for rapid growth and transformation occurring in the industry yet remain focused on value-based care. CIOs and key stakeholders need to drive the direction by being actively involved in developing IT planning, documentation and deliverables to support key financial investment decisions.

New Planning Strategies and Approach

We may have the best methodologies, planning processes and procedures in place, but we need to be willing to embrace and develop new approaches of planning that will help transform the healthcare culture. Healthcare CIOs must be willing to change their thinking when it comes to developing organizational business goals and initiatives. The CIOs will need to collaborate with IT departments and other stakeholders to develop thorough and effective planning methods that will support and expedite outcomes. This means adjusting the way we think and interact, eliminating silos, ensuring the roadmap leads us to maximize results by revisiting the plan often, monitoring and measuring progress and preparing us for anticipated growth. By following a more streamlined strategic approach and focusing on agility, teams can easily adapt to any industry disruptors and be prepared to adjust to changing technology solutions. Whether the goal is to improve data workflow and the patients experience, implement and deploy analytics or interoperability, it is important to stay integrated through the entire strategic planning process.

Key Components

Building and retaining the right team to accomplish the goals set forth by leadership is important and should be included as part of the overall strategy. Assessing the inhouse skills, redundancies, succession planning and restructuring are all key planning components. Determining training needs, development and implementation of training programs will promote employee retention. Developing policies to help reach the strategic plans goals, implementing strong risk management and mitigation plans, and establishing timelines with key milestones will help manage the plan. Finally, developing effective communication strategies will encourage healthy relationships, promote innovation, enhance productivity and contribute to growth. All these things bring value in understanding and realizing the strategic components.


Engaging the right stakeholders initiates a strategy to improve organizational outcomes. Good governance will help identify and organize high-level opportunities for outcome improvement, implement an improvement methodology to organize teams, assign accountability and empower individuals. By recruiting the right mix of people as part of the leadership team, including a variety of multidisciplinary stakeholders, this will ensure everyone has a voice. Establishing an effective governance model provides a solid foundation to successfully drive the project, improve efficiency, provide sustainability and less corruption. All of this means lower costs, improved quality and satisfied stakeholders.

Measure Success

It’s important that once you spend the resource hours developing the strategic plan and communicating and the overall goals, you then measure progress and understand the components that drive performance. A strategy management system contains an aligned set of objectives, measures, targets and initiatives that describe the strategy. By developing measures of success and key performance indicators (KPIs) to help measure organizational or departmental performance, you can focus on and adjust relevant information, driving your plan to success.


Nina De Los Santos, PMP

VP Operation Delivery