Ob-Gyn Coding Alert

Reader Questions:

Highlight ICD-10-CM Guidelines for Adverse Prescription Reaction Dx

Question: I’m working on an office visit for a patient previously treated with antibiotics for a kidney infection following an ectopic pregnancy. The chart states that the patient has experienced an allergic reaction (mild fever, rashes) to ciprofloxacin following treatment. What’s the correct ICD-10-CM coding?

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Answer: The kidney infection is the underlying reason for the visit. For that diagnosis, you should be cognizant of the fact that the kidney infection is associated with the ectopic pregnancy. Within the ICD-10-CM Alphabetic Index, you find that a kidney infection following an ectopic gestation leads you to O08.83 (Urinary tract infection following an ectopic and molar pregnancy).

Since the allergic reaction is related to treatment for the underlying visit, include the complication to a prescribed medication (and adverse reactions) as secondary codes. The coding for complications following prescribed medication depends on a few variables. These include the type of medication prescribed and the means/intent of the patient when taking the medication. For instance, when a patient experiences a reaction to an antibiotic prescription, you report a code from category code T36 (Poisoning by, adverse effect of and underdosing of systemic antibiotics). From there, you will consider the type of antibiotic and the means in which the patient was poisoned (accidental, adverse effect, intentional self-harm, undetermined, etc.).

Before considering codes and sequencing of codes, review the applicable guidelines in the ICD-10-CM code book. Consider the following instructions on coding adverse effect diagnoses from Section I.C.19.e.5.a:

“When coding an adverse effect of a drug that has been correctly prescribed and properly administered, assign the appropriate code for the nature of the adverse effect followed by the appropriate code for the adverse effect of the drug (T36-T50). The code for the drug should have a 5th or 6th character “5” (for example T36.0X5-).”

These guidelines instruct you to code the symptoms followed by the poisoning code from category code T36. For the fever, report code R50.9 (Fever, unspecified), but reporting the rash requires a little more digging or you might incorrectly report code R21 (Rash and other nonspecific skin eruption). In the ICD-10-CM Alphabetic Index, find Rash ? drug (internal use), which leads you to code L27.0 (Generalized skin eruption due to drugs and medicaments taken internally).

Finally, you will home in on the correct fourth character under category code T36. Adverse reactions to penicillin may be reported as T36.0 (Poisoning by, adverse effect of and underdosing of penicillins), but you will find no such luck with ciprofloxacin. Instead, you should report code T36.8X5A (Adverse effect of other systemic antibiotics, initial encounter).