Coding, Classification and Reimbursement

Attempted Overdose of Pregnant Patient

  • 1.  Attempted Overdose of Pregnant Patient

    Posted 01-11-2019 17:34
    Hello,

    I would love to get feedback regarding a chart I am working on. The patient was transferred to our inpatient behavioral health facility after being stabilized/cleared at an ED after an attempted suicide via aspirin overdose and the patient is 16 weeks pregnant.

    Primary Diagnosis: MDD, recurrent, severe, w/o psychotic features
    Secondary:
    1. status post medication overdose on aspirin, hemodynamically stable
    2. second trimester pregnancy, 16 weeks
    3. marijuana dependency, current use
    4. urinary tract infection

    I was thinking of coding: F33.2, O99.342, T14.91xD, O9A.212, T39.012D, O99.322, F12.20, Z3A.16, O23.42, N39.0

    Again I would love any feedback regarding the codes. Thank you!

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    Megan Del Rio
    His Discharge Coder
    mparnt@gmail.com
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  • 2.  RE: Attempted Overdose of Pregnant Patient

    Posted 01-11-2019 17:39

    Hello

    According to Ch 15 guidelines for coding obstetrics, obstetric codes take sequencing precedence over other chapters – unless the physician specifically states there is no relationship between the two.  In this scenario as noted below, I would sequence the Complication of pregnancy with mental disorders as the principal diagnosis, followed by MDD and all other codes.

     

    Respectfully,

    Lynn Wall

     






  • 3.  RE: Attempted Overdose of Pregnant Patient

    Posted 01-17-2019 17:44
    I could be wrong and please tell me if my logic is incorrect. Unless the physician said that the over dose would need continued monitoring I wouldn't code it and code SI  instead. Because if pt. is stable the overdose is a previously treated condition.

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    Theresa Guerra, RHIT
    HIM Coder
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  • 4.  RE: Attempted Overdose of Pregnant Patient

    Posted 01-20-2019 15:51
    I agree with Lynn that the pregnancy code should be the principal diagnosis--pregnancy with mental disorder, I believe, followed by the depression code.  I would think (and hope) that the patient's treatment for her depression would be affected by her pregnancy.

    I also agree with coding subsequent encounter for the overdose.  The overdose should not be actively treated at this point but the patient still might be monitored for the after-effects of the overdose.

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    Alicia Kellogg, RHIT
    Inpatient Coder
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  • 5.  RE: Attempted Overdose of Pregnant Patient

    Posted 01-21-2019 13:04
    I did list the pregnancy codes first followed by the corresponding Ch. 5 codes. The doctor did state her treatment was affected by her pregnancy; certain medications could not be prescribed. I appreciate all input on this one! It is not a chart we typically get; our facility rarely has pregnant patients.

    I also typically code subsequent encounter for any patients who have attempted suicide via overdose and are transferred directly to our facility from the ED because I feel from what the doctors put in their notes, the patients are still being monitored during their recovery/healing phase. Our doctors usually state "Status Post Medication Overdose" and there is no status Z code for overdose. There is also an exclude 1 under R45.851 for suicide attempt (T14.91--). The key phrase is receiving care during the healing or recovery phase. When the patients are medically cleared (not going to have any extensive measures that requires them to return to the ED) my interpretation is that the patients are transferred to our facility, typically on a 5150, for continued monitoring of the overdose and depression (which typically lead to the overdose). If the patient attempted suicide via overdoes and never went into the ED and stated this occurred a week ago upon admission, then I code Z91.5 and if they are having current suicidal ideation also R45.851. I hope that helps you see the thought process behind using subsequent encounter Theresa.

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    Megan Del Rio
    His Discharge Coder
    mparnt@gmail.com
    ------------------------------