Coding, Classification and Reimbursement

Cannaboid hyperemesis syndrome

Robin L Millard-Sparacino, Merchandising and Marketing,RHIT,R.H.I.T, AHIMA A01-09-2019 15:12

Shirley Brodginski, MA,RHIA,CHDA,CCS-P,CPMA, CPCD, CPEDC01-14-2019 08:05

  • 1.  Cannaboid hyperemesis syndrome

    Posted 01-09-2019 14:44
    ​​Hello all ~
    How would you code cannaboid hyperemesis syndrome?  I'm not having much luck finding the right diagnosis code though what I did come up with was F12.288 - cannabis dependence with other cannabis-induced disorder.  Cannabis was documented at dependence.
    Appreciate the assistance.
    Thanks -

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    Lynn A. Wall, RHIT, CCS
    Interim Coding Supervisor
    Maricopa Integrated Health System
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  • 2.  RE: Cannaboid hyperemesis syndrome

    Posted 01-09-2019 15:12
    I would suggest  T40.7x1 (A or D) for it is an unintentional poisoning from the cannabis, followed by R11.2 for the nausea and vomiting, then F12.20 for cannabis dependence.

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    Robin Millard-Sparacino,RHIT,BS AHIMA Approved ICD 10CM& PCS Trainer
    HIM TECH
    Madden Mental Health
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  • 3.  RE: Cannaboid hyperemesis syndrome

    Posted 01-10-2019 07:13
    There is an excellent AHIMA reference that I have found helpful:

    https://www.mahima.org/coding-tip-cannabinoid-hyperemesis-syndrome/

    When you open the article in the MA AHIMA website the sidebar has a link called Coding Tips which also has other coding tips that are useful.

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    Deborah Simmons, CCS, CCDS,CPC, CHISP
    Approved ICD-10-CM/PCS Trainer
    HIM Sr. Consultant
    Jzanus Consulting, Inc
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  • 4.  RE: Cannaboid hyperemesis syndrome

    Posted 01-10-2019 10:11

    Thank you!

     






  • 5.  RE: Cannaboid hyperemesis syndrome

    Posted 01-11-2019 11:49
    ​I just wanted to thank you for sending this link. It's very informative and I've added it to my toolbar to use if I need answers. Thank you again.

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    Teresa Mathews
    Coding Assistant
    Premier Bone and Joint Centers
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  • 6.  RE: Cannaboid hyperemesis syndrome

    Posted 01-11-2019 09:14
    Hi Lynn,
    IWhen I first saw this dx a few years ago I coded it to an accidental poisoning.
    I was instructed by the coding manager at that time to code it to:
    G43A0 Cyclical vomiting, not  intractable (unless intractable documented), and
    T407X5A Adverse effect of cannabis (derivatives), initial encounter.

    I can find not guidelines or Coding Clinics to support these codes but this was the client's request.

    Laura C Jones, RHIT, CCS
    ICD 10 CM/PCS Coding Validator





  • 7.  RE: Cannaboid hyperemesis syndrome

    Posted 01-11-2019 10:20
    In ICD-9 it was appropriate to use the code for cyclical vomiting in the scenario when the Physician documented cyclical vomiting in the setting of cannabis abuse.   But in ICD-10 the code for cyclical vomiting is now linked to migraine headaches in the Neurology section of the Tabular Listing therefore it is no longer appropriate to use with cannabis hyperemesis syndrome.  See the ICD-10-CM listings below.   Also there is a Coding Clinic 1Q 2017 Pg 28 Cyclical Vomiting that may be helpful.

    Vomiting > cyclical

    Cyclical Vomiting
    Hope this is helpful.

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    Deborah Simmons, CCS, CCDS,CPC, CHISP
    Approved ICD-10-CM/PCS Trainer
    HIM Sr. Consultant
    Jzanus Consulting, Inc
    ------------------------------



  • 8.  RE: Cannaboid hyperemesis syndrome

    Posted 01-11-2019 22:26
    There is the indented option for "without refractory migraine".





  • 9.  RE: Cannaboid hyperemesis syndrome

    Posted 01-14-2019 09:33
    I see your point Laura, but the code for cyclical vomiting is in the Neurology section of the Tabular Listing linked with a migraine headache.  Since Poisoning is a metabolic function I would not select a code from the Neurology section. There is also a coding clinic that specifically states not to use this code when a migraine is not present:

    Cyclical Vomiting

    I hope this is helpful.

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    Deborah Simmons, CCS, CCDS,CPC, CHISP
    Approved ICD-10-CM/PCS Trainer
    HIM Sr. Consultant
    Jzanus Consulting, Inc
    ------------------------------



  • 10.  RE: Cannaboid hyperemesis syndrome

    Posted 01-12-2019 13:32
    The I10 Handbook states "An acute condition due to a reaction resulting from the interaction of alcohol and one or more drugs or due to a drug involved in abuse or dependence is classified as a poisoning". Coding Clinic 1Q 1993 pg 25 advises to code Chest pain due to cocaine intoxication as a poisoning not an adverse effect of the correct substance taken correctly. (Cocaine Intoxication in the Alphabetic index is linked directly to see Abuse) If your patient also has a diagnosis of either cannaboid abuse/dependence, I would recommend reporting it as a poisoning. F12.188 or F12.288 (Cannabis abuse/dependence with other cannabis-induced disorder) can be assigned as an additional diagnosis per Excludes 2 Note under section (T36-T50). If abuse/dependence is not documented, then I would go with F12.988, Cannabis use unspecified, with other cannabis use disorder and R11.2, Nausea with vomiting unspecified as a secondary dx. It would not be an adverse reaction unless the cannabis was correctly prescribed and properly administered (medical marijuana). Guidelines state: "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)". Coding Clinic 2Q 2011 pg 7 states that in this instance, medical marijuana is not considered drug abuse since the physician has prescribed the drug for medicinal purposes (along with the disclaimer that this is intended solely as coding advice and should not be taken as a comment or approval regarding the utility or legality of medical use of marijuana!)





  • 11.  RE: Cannaboid hyperemesis syndrome

    Posted 01-14-2019 08:05

    Can you point to where the I10 reference you give is found? I have searched the guidelines and cannot locate it.

     

    Shirley Brodginski

    MA, RHIA, CHDA, CCS-P, CPMA, CPCD, CPEDC

    Technician/Coder

    Health Information Management

     

    ArnotHealth

    St. Joseph's Campus 607-733-6541 x7990

     



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  • 12.  RE: Cannaboid hyperemesis syndrome

    Posted 01-14-2019 09:23
    It is in the I10 Handbook, Chapter 32 Poisoning, Toxic Effects, Adverse Effects, and Underdosing of Drugs-Poisoning due to substance abuse or dependence.

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    Karen Neal
    Coding Quality Auditor
    Conifer Health Solutions
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  • 13.  RE: Cannaboid hyperemesis syndrome

    Posted 01-15-2019 09:45
    ​The I10 handbook is very helpful. However, remember, it is not an official reference.  Codebook, then guidelines, then Coding Clinic.  I'm not sure I saw any reference to medical marijuana in the discussion?


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    Susan Roehl
    Consultant
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  • 14.  RE: Cannaboid hyperemesis syndrome

    Posted 01-15-2019 17:14
    No medical marijuana was not mentioned. I included that because this would go to a poisoning if the patient had abuse/dependence- it would not be considered drug abuse though if the marijuana had been prescribed. That was my point of mentioning the medical marijuana since we were discussing cannabis.

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    Karen Neal
    Coding Quality Auditor
    Conifer Health Solutions
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  • 15.  RE: Cannaboid hyperemesis syndrome

    Posted 01-15-2019 17:33
    ​I think this conversation has taken on a life of it's own :)   I don't believe there was ever mention of abuse, dependence, etc.- but a lot of the references/CC responses being shared are using the terms abuse and/or dependence.  As more and more states legalize the use of either medical or recreational, or both - we are definitely going to need further guidance and the appropriate coding of any side effects/complications/ etc. as they related to use, abuse, and dependence. The cyclical vomiting related to marijuana use appears to be more along the adverse effect  or side effect of chronic use.  This is from the Mayo Clinic website:  Chronic use of marijuana (Cannabis sativa) also has been associated with cyclic vomiting syndrome because some people use marijuana to treat their symptoms. However, cannabis can lead to a condition called cannabis hyperemesis syndrome, which typically leads to persistent vomiting without normal intervening periods. People with this syndrome often demonstrate frequent showering or bathing behavior. Cannabis hyperemesis syndrome can be confused with cyclic vomiting syndrome. To rule out cannabis hyperemesis syndrome, you need to stop using marijuana for at least one to two weeks to see if vomiting lessens. If it doesn't, your doctor will continue testing for cyclic vomiting syndrome.


    IF it is medical marijuana and not taken as prescribed, we may be in the poisoning category.  In North Dakota, there will be no prescriptions for medical marijuana, only certifications. If it is determined the patient meets the criteria for the "flowers and buds" (i.e. smokable marijuana) that requires a separate certification.
    This has been a really good conversation and certainly raised a lot of questions and discussion!

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    Susan Roehl
    Consultant
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  • 16.  RE: Cannaboid hyperemesis syndrome

    Posted 01-15-2019 13:32
    OGCR I.C.19. e. 5)(b)(iv)
    19. Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)
    e. Adverse Effects, Poisoning, Underdosing and Toxic Effects
    5) The occurrence of drug toxicity is classified in ICD-10-CM as follows:
    (b) Poisoning
    Examples of poisoning include: (iv)Interaction of drug(s) and alcohol
    When a reaction results from the interaction of a drug(s) and alcohol, this would be classified as poisoning.
    --
    Sent from Postbox





  • 17.  RE: Cannaboid hyperemesis syndrome

    Posted 01-14-2019 09:36
    Per Coding Guidelines Chapter 5 - the codes for psychoactive substance use disorders (F10.9-, F11.9-, F12.9-, F13.9-, F14.9-,F15.9-, F16.9-) should only be assigned based on provider documentation and when they meet the definition of a reportable diagnosis.  The codes are to be used only when the psychoactive substance use is associated with a physical, mental or behavioral disorder, and such a relationship is documented by the provider.  In this case assign - F12.988 - Cannabis use, unspecified with other cannabis-induced disorder.  Per Coding Clinic 1Q 2017 - "assign K31.89, other diseases of stomach and duodenum, along with the appropriate code from category R11, nausea and vomiting.  Since K31.89 does not specifically identify the disease process of cyclical vomiting syndrome, it is appropriate to assign an additional code from category R11 to capture the vomiting".   The documentation in this case may or may not include "syndrome", however K31.89 is not specific to "syndrome", so would be appropriate

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    Susan Roehl
    Consultant
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  • 18.  RE: Cannaboid hyperemesis syndrome

    Posted 01-14-2019 10:49
    I got a response from Coding Clinic dated 11/30/18 on how to code "cannabinoid hyperemesis syndrome due to cannabis abuse". Their response was to assign T40.7X1A, poisoning by cannabis, R11.2, nausea with vomiting, and F12.10, They stated F12.188, cannabis abuse with other cannabis-induced disorder, was not appropriate because that code is assigned for cannabis-induced mental health disorders.

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    Ashley Sparks
    Him Coding Liaison
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  • 19.  RE: Cannaboid hyperemesis syndrome

    Posted 01-14-2019 10:52

    Thank you both – good detail and information. 

     






  • 20.  RE: Cannaboid hyperemesis syndrome

    Posted 01-14-2019 11:17
    ​That's interesting Ashley, as the 2019 Guidelines clearly state "physical, mental, or behavioral disorder".  The 2018 Guidelines stated mental or behavioral.  If they responded to your question in November of 2018, the response (per my interpretation of the Guidelines) is in error.  Thanks!

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    Susan Roehl
    Consultant
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  • 21.  RE: Cannaboid hyperemesis syndrome

    Posted 01-14-2019 11:33
    Thank you Ashley, very helpful.   I wish AHA would publish this in Coding Clinic to make everyone's life easier.

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    Deborah Simmons, CCS, CCDS,CPC, CHISP
    Approved ICD-10-CM/PCS Trainer
    HIM Sr. Consultant
    Jzanus Consulting, Inc
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