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order of diagnoses

  1. #1
    Default order of diagnoses
    Medical Coding Books
    Please give opinions on the order of importance in these diagnoses. 780.2, 518.81 and 967.8.

    Thanks for any help.

  2. #2
    Well I'm assuming that these are for inpatient charges, and the order is very important. I see it like this; the patient OD on some type of sedative which caused the respiratory failure and syncope. So I would code as
    1) 518.81
    2) 780.2
    3) 967.8
    4) E852.9 or E950.2 (depending on whether it was an accident or suicide attempt.
    I code inpatient trauma and pulmonolgy so this is how I would do it. Hope this helps.

  3. #3
    Sorry. This is actually for ER evaluation. I forgot to put that on the message.


  4. #4
    Columbia, MO
    If you read the guidelines then you will see if it is a poisoning the the 9xx.xx code for poisoning by agent goes first the the effects of the poisoning (resp distress ) is secondary followed by any other dx and then the E code.. If it is an adverse effect then the resp failure goes first followed by the E code for the adverse effect by agent.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Thank you, goes to show you can always learn something on here. I hadn't read the guidelines. I'm going to look at them now as my supervisor ALWAYS wants the respiratory failure or distress to go first.

  6. Default
    If you are asking the order of the diagnosis means first mention the reason for the visit, then only able to order the dxs...

    Nalini CPC

  7. #7
    Columbia, MO
    here is the section for you.. it starts on page 59:
    Adverse Effect
    When the drug was correctly prescribed and properly administered, code the reaction plus the appropriate code from the E930-E949 series. Codes from the E930-E949 series must be used to identify the causative substance for an adverse effect of drug, medicinal and biological substances, correctly prescribed and properly administered. The effect, such as tachycardia, delirium, gastrointestinal hemorrhaging, vomiting, hypokalemia, hepatitis, renal failure, or respiratory failure, is coded and followed by the appropriate code from the E930-E949 series
    (e) Sequencing of poisoning
    When coding a poisoning or reaction to the improper use of a medication (e.g., wrong dose, wrong substance, wrong route of administration) the poisoning code is sequenced first, followed by a code for the manifestation. If there is also a diagnosis of drug abuse or dependence to the substance, the abuse or dependence is coded as an additional code.
    (b) Sequencing toxic effect codes
    A toxic effect code should be sequenced first, followed by the code(s) that identify the result of the toxic effect

    Debra A. Mitchell, MSPH, CPC-H

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