Resolved Underdosing

[MaryW_64032]

The way I am taking the underdosing is that if a pt is taking meds for copd and they are taking it less than prescribed let’s say it’s prescribed every 6 hrs 4 times a day and pt is taking it every other day . Pt final copd Exacerbation And noncompliance of med. Per the guideline (if I am understating correctly ) I would code the copd exacerbation and T (Under dosing ) code As it says assign the code for the condition itself and a z code for noncompliance? What if there is no exacerbation how would you code this copd and the t code And non compliance ? Thank you

 

[Lori]

Underdosing

means that a patient has taken less of a medication than is prescribed by the provider or the manufacturer’s instruction. For underdosing, use a code from categories T36-T50 (fifth or sixth character “6”).

• Codes for underdosing should never be assigned as principal or first-listed codes.
• If a patient has a relapse or exacerbation of the medical condition for which the drug is prescribed because of the reduction in dose, then the medical condition itself should be coded.
• Noncompliance (Z91.12-, Z91.13-) or complication of care (Y63.6-Y63.9) codes are to be used with an underdosing code to indicate intent, if known

Codes in categories T36-T65 are combination codes that include the substance that was taken and the intent in which they were taken. No external cause codes are required for poisonings, toxic effects, adverse effects and underdosing codes.

• If the same code would describe the causative agent for more than one adverse reaction, poisoning, toxic effect or underdosing, assign the code only once.
• If two or more drugs, medicinal or biological substances are reported, code each individually unless a combination code is listed in the Table of Drugs and Chemicals.
• Use as many codes as necessary to describe completely all drugs, medicinal or biological substances.
• Do not code directly from the Table of Drugs and chemicals. Always refer back to the tabular list.

Non-compliance Codes –
The use of the non-compliance codes protects the provider legally by documenting when patients are not taking their medication as prescribed or are non-compliant with their treatment. Reporting non-compliance codes aides in the tracking and trending of how many people do not take their medication correctly, or forgo treatment recommendations, and the reasons why.
For example, there is a code for non-compliance of medication regimen due to financial hardship. If the code is widely used, it will show how many people do not have the money to pay for their prescriptions. This will show a need to decrease the cost of prescriptions, and that more programs are necessary to help patients receive the medications they need.

Z91.14 patient's other noncompliance with medication regimen

Some of the common underlying reasons for non-compliance such as:

• Intentional Underdosing of Medication Regimen Due Financial Hardship (Z91.120)
• Unintentional Underdosing of Medication Regimen Due to Age-Related Debility (Z91.130)
• Intentional/Unintentional Underdosing for Other Reason (Z91.128/Z91.138)
• Underdosing of Medication NOS (Z91.14)

ICD-10-CM Guideline:

19. Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)

e. Adverse Effects, Poisoning, Underdosing and Toxic Effects Codes in categories T36-T65 are combination codes that include the substance that was taken as well as the intent. No additional external cause code is required for poisonings, toxic effects, adverse effects and underdosing codes. ICD-10-CM Official Guidelines for Coding and Reporting FY 2020 Page 81 of 121 1) Do not code directly from the Table of Drugs Do not code directly from the Table of Drugs and Chemicals. Always refer back to the Tabular List. 2) Use as many codes as necessary to describe Use as many codes as necessary to describe completely all drugs, medicinal or biological substances. 3) If the same code would describe the causative agent If the same code would describe the causative agent for more than one adverse reaction, poisoning, toxic effect or underdosing, assign the code only once. 4) If two or more drugs, medicinal or biological substances If two or more drugs, medicinal or biological substances are taken, code each individually unless a combination code is listed in the Table of Drugs and Chemicals. If multiple unspecified drugs, medicinal or biological substances were taken, assign the appropriate code from subcategory T50.91, Poisoning by, adverse effect of and underdosing of multiple unspecified drugs, medicaments and biological substances. 5) The occurrence of drug toxicity is classified in ICD-10- CM as follows:

(c) Underdosing
Underdosing refers to taking less of a medication than is prescribed by a provider or a manufacturer’s instruction. Discontinuing the use of a prescribed medication on the patient's own initiative (not directed by the patient's ICD-10-CM Official Guidelines for Coding and Reporting FY 2020 Page 83 of 121 provider) is also classified as an underdosing. For underdosing, assign the code from categories T36-T50 (fifth or sixth character “6”). Codes for underdosing should never be assigned as principal or first-listed codes. If a patient has a relapse or exacerbation of the medical condition for which the drug is prescribed because of the reduction in dose, then the medical condition itself should be coded. Noncompliance (Z91.12-, Z91.13- and Z91.14-) or complication of care (Y63.6-Y63.9) codes are to be used with an underdosing code to indicate intent, if known.

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[Lori]

ICD-10-CM Official Guidelines for Coding and Reporting
FY 2020

10. Chapter 10: Diseases of the Respiratory System (J00-J99)
a. Chronic Obstructive Pulmonary Disease [COPD] and Asthma
1) Acute exacerbation of chronic obstructive bronchitis and asthma.
The codes in categories J44 and J45 distinguish between
uncomplicated cases and those in acute exacerbation. An acute
exacerbation is a worsening or a decompensation of a chronic
condition. An acute exacerbation is not equivalent to an
infection superimposed on a chronic condition, though an
exacerbation may be triggered by an infection.


b. Acute Respiratory Failure
1) Acute respiratory failure as principal diagnosis
A code from subcategory J96.0, Acute respiratory failure, or
subcategory J96.2, Acute and chronic respiratory failure, may
be assigned as a principal diagnosis when it is the condition
established after study to be chiefly responsible for occasioning
the admission to the hospital, and the selection is supported by
the Alphabetic Index and Tabular List. However, chapter
specific coding guidelines (such as obstetrics, poisoning, HIV,
newborn) that provide sequencing direction take precedence.
2) Acute respiratory failure as secondary diagnosis
Respiratory failure may be listed as a secondary diagnosis if it
occurs after admission, or if it is present on admission, but does
not meet the definition of principal diagnosis.
3) Sequencing of acute respiratory failure and another
acute condition
When a patient is admitted with respiratory failure and another
acute condition, (e.g., myocardial infarction, cerebrovascular
accident, aspiration pneumonia), the principal diagnosis will not
be the same in every situation. This applies whether the other
acute condition is a respiratory or nonrespiratory condition.
Selection of the principal diagnosis will be dependent on the
circumstances of admission. If both the respiratory failure and
the other acute condition are equally responsible for occasioning
the admission to the hospital, and there are no chapter-specific
sequencing rules, the guideline regarding two or more diagnoses
that equally meet the definition for principal diagnosis (Section
II, C.) may be applied in these situations.
If the documentation is not clear as to whether acute respiratory
failure and another condition are equally responsible for
occasioning the admission, query the provider for clarification.

Chronic obstructive pulmonary disease (COPD) is a general term used to describe a variety of conditions that result in obstruction of the airway. ICD-10-CM classifies these conditions to category J44, Other chronic obstructive pulmonary disease. Category J44 includes the following clinical terms: asthma with chronic obstructive pulmonary disease; chronic asthmatic (obstructive) bronchitis; chronic bronchitis with airways obstruction; chronic bronchitis with emphysema; chronic emphysematous bronchitis; chronic obstructive asthma; chronic obstructive bronchitis and chronic obstructive tracheobronchitis.

Chronic obstructive pulmonary disease with acute lower respiratory infection: Assign code J44.1 for COPD with a lower respiratory infection. Use an additional code to identify infection. Note that acute bronchitis is included in this code.

Chronic obstructive pulmonary disease with (acute) exacerbation: Assign code J44.2 for COPD with (acute) exacerbation. This code includes decompensated COPD and decompensated COPD with (acute) exacerbation. Note this code does NOT include acute bronchitis

Chronic obstructive pulmonary disease, unspecified: Assign code J44.9 for COPD. This code includes chronic obstructive airway disease NOS and chronic obstructive lung disease NOS.

J44.9
Chronic obstructive pulmonary disease, unspecified.

J44.1 - Chronic obstructive pulmonary disease with (acute) exacerbation​

Code​

J44.1 - Chronic obstructive pulmonary disease with (acute) exacerbation

Includes​

• Decompensated COPD
• Decompensated COPD with (acute) exacerbation

Not Included Here​

• chronic obstructive pulmonary disease [COPD] with acute bronchitis (J44.0)
• lung diseases due to external agents (J60-J70)

Code Tree​

J00-J99- Diseases of the respiratory system

• J40-J47- Chronic lower respiratory diseases
  • J44- Other chronic obstructive pulmonary disease
    • J44.0 - Chronic obstructive pulmonary disease with (acute) lower respiratory infection
    • J44.1 - Chronic obstructive pulmonary disease with (acute) exacerbation
    • J44.9 - Chronic obstructive pulmonary disease, unspecified

https://providers.bcbsal.org/portal/documents/10226/306297/Correctly+Coding+Chronic+Lower+Respiratory+Diseases+(COPD)/aef601a9-3f3b-43ac-b5b7-3ea55510e513?version=1.0

https://www.cigna.com/iwov-resources/medicare-2015/docs/icd10-copd.pdf

Chronic Obstructive Pulmonary Disease (COPD) and Asthma

COPD is a chronic inflammatory lung disease that causes obstructed flow of air from the lungs. The disease is progressive in nature and typically will worsen over time.

www.hiacode.com

ICD-10-CM: 3 Official Tips for More Accurate COPD Coding

Check out these tips for COPD coding accuracy.

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[WhitneyH_24046]

Thanks for the great info Lori!