Here’s How ICD-10-CM Official Guidelines Apply to New Ecstasy Poisoning Codes

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ICD-10-CM 2019 is adding a new subcategory for “poisoning by ecstasy,” effective Oct. 1, 2018. Poisoning is one of those coding terms that has a more complex meaning than you may first suspect. Read on to get clarity on when to use these new codes.

Catch Complete Character Requirements for Ecstasy Codes

ICD-10-CM 2019 adds subcategory T43.64- (Poisoning by ecstasy). Notes with the code tell you that other terms you may see include poisoning by MDMA and poisoning by 3,4-methylenedioxymethamphetamine.

If you’re looking at the ICD-10-CM 2019 addenda PDF from the CDC site, you’ll see these new additions, too:

  • T43.641 (Poisoning by ecstasy, accidental (unintentional))
    • Poisoning by ecstasy NOS
  • T43.642 (Poisoning by ecstasy, intentional self-harm)
  • T43.643 (Poisoning by ecstasy, assault)
  • T43.644 (Poisoning by ecstasy, undetermined).

Careful: These codes require one of these seventh characters to be complete, reportable codes:

  • A, initial encounter
  • D, subsequent encounter
  • S, sequela.

Tip: Some ICD-10 resources list seventh character requirements at the category level rather than at code level. Choose an ICD-10-CM resource that lists seventh character requirements at code level so you don’t miss these required characters.

Follow These Guidelines to Code Poisoning Correctly

Knowing the ICD-10-CM Official Guidelines related to these codes will help ensure you use them correctly from the start.

Seventh characters: Remember that you should choose the seventh character based on what’s going on with the case, not based on whether the doctor has seen the patient before. You’ll find these rules in section I.C.19.a of the Official Guidelines:

  • Use A (initial encounter) for each encounter for active treatment of the condition.
  • Use D (subsequent encounter) when the patient is receiving routine care during healing or recovery. Don’t use an aftercare Z code for poisoning cases where you have the option of the D seventh character.
  • Use S (sequela) when the patient presents for complications or conditions resulting from the condition. Code the resulting condition first, and then report the T code with the character S at the end.

Number of codes: In section I.C.19.e, you’ll find guidelines about how many codes to report:

  • Combo codes: The codes in T36-T65 describe the substance and the intent. In the case of our new codes, the descriptors refer to both ecstasy and poisoning. That means you should not need an additional adverse effect code.
  • One code or more: If more than one substance is involved, you can use multiple codes. But if one code applies to more than one adverse reaction, you should report that code only once.
  • Code these, too: You should report additional codes for any manifestations of the poisoning. And assign a code for abuse or dependence if that diagnosis is documented.

Important term tips: To use the new codes correctly, understanding how to report intent and knowing what ICD-10-CM categorizes as “poisoning” is essential:

  • Intent: The Official Guidelines include an important pointer about coding poisoning: “If the intent of the poisoning is unknown or unspecified, code the intent as accidental intent. The undetermined intent is only for use if the documentation in the record specifies that the intent cannot be determined.” Helpful: The note “poisoning by ecstasy NOS” with “accidental” code T43.641- should help you remember that rule.
  • Understand ‘poisoning’: For ecstasy, keep in mind that the Official Guidelines consider all of these to be poisoning:
    • An overdose of a drug intentionally taken or administered
    • Toxicity resulting from interaction of a nonprescribed drug and a properly administered drug
    • A reaction resulting from a drug and alcohol.

What About You?

Are there any drugs you think ICD-10-CM should add more specific poisoning codes for? Do you find it helpful to have codes that list the drug’s name rather than a category?

 

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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