ED Coding and Reimbursement Alert

The key to receiving proper reimbursement for medication poisoning depends entirely on whether the patient took a drug correctly or inappropriately. The ED physician must first determine if the patient suffers from a poisoning or an adverse reaction to a drug.
 
An adverse effect occurs when a medication is properly administered and correctly prescribed and the patient has an ill effect. A poisoning should be coded if drugs, medications or other substances that are not used in accordance with a physician's instruction cause the reaction. 
Reporting Poisoning  
The Table of Drugs and Chemicals, which is after the alphabetical listing in ICD9 Codes, is the tool to use for accurately coding poisonings. It contains an extensive list of drugs, industrial solvents, corrosives, gases, noxious plants, pesticides and other toxic agents. The table is structured to identify the substance, the corresponding poisoning code and the circumstances of the poisoning or adverse effect. This last category uses E codes (external cause) to cover accident, therapeutic use, suicide attempt, assault and undetermined (when the intent of the poisoning or injury cannot be determined as intentional or accidental).
 
Note: 1) Many carriers do not require that ED physicians assign an E code when reporting a poisoning. However, you should use these external-cause codes even if the payer considers it optional because they help clarify the incident and provide accurate statistics. 2) Do not confuse E codes used to describe the external cause in poisoning cases with the therapeutic E codes used when a patient's illness is caused by an adverse reaction. Therapeutic E codes should not be assigned in poisoning cases.
 
Terms normally associated with a drug poisoning include overdose, poisoning, wrong substance given or taken, and intoxication. Examples of how poisonings occur include an overdose taken to attempt suicide, the wrong dosage is given or taken, a medication (prescription or nonprescription) is combined with alcohol, a prescription drug is taken with an over-the-counter drug, or an illegal drug is taken or there is intoxication (other than a cumulative effect).
 
You'll need at least three codes to correctly report a poisoning in just about every poisoning case. And the way you sequence the codes depends on the intent and effect of the poisoning.
 
Identify the drug that has caused the poisoning as it is described in the Table of Drugs and Chemicals. The first code to list will be from the poisoning column and identifies the drug or chemical. The second code indicates the condition (e.g., coma or stupor) resulting from the poisoning. The third code (E code) identifies the cause of the poisoning as [...]