Poisoning Codes - need clairification please


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Maryland Value Options Medicaid (Behavioral Health) will cover poisoning codes in categories T36-T50; however, not all codes. Is it correct to assume that those codes in T36-T50 ending with 5 or 6 (adverse effect and underdosing) are not poisoning codes? We need to flag the poisoning T36-T50 codes so that we make sure certain ones are submitted as behavioral health and the others as non-behavioral health.


True Blue
Columbia, MO
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Adverse effect and underdosing are not poisoning codes.
Poisoning has four choices:
Accidental - the patient took more medication that prescribed "accidentally" causing a harmful outcome
Intentional - the patient took more than prescribe with the intent of causing a harmful outcome
Assault - the patient is administered a drug without the patient knowledge or consent
Undetermined - the provider documents that it cannot be determined if the patient intent was harmful
The definition of the other two
Adverse effect - the patient takes the drug correctly and it affects the patient in a negative fashion
Underdosing- the patient takes less than the prescribed amount or does not take the drug at all causing the condition to persist.
When using one of the four poisoning choices the T code for the substance is coded first listed, with 7th character A, D, or S.
The adverse effect and the underdosing T codes are secondary.