Template:ICD10 Guideline overdose: Difference between revisions

Revision as of 09:32, 2019 October 10

This template is used for the dxs in the Category:Adverse effect to consistently explain how to use them.

To use:

Overdose/toxicity codes

This category is in relation to pharmaceuticals and other biological substances (as opposed to Category:Poisoning by non-pharmaceuticals)
To qualify for these codes, there must be a threat to life, or limb, or to functioning for one or more organs AND there was an INAPPROPRIATE dosing regimen -- thus the threat was a consequence of an overdose
- e.g. opioid overdose can cause respiratory arrest or shock, both of which can be life threats
- e.g. acetominophen overdose puts the liver at risk of failing
There is no assumption here about whether the overdose was accidental or not -- if it was a suicide attempt, then you should link the overdose code with Suicide attempt (intentional self-harm)
In addition to a number of codes for specific agents (e.g. insulin), or classes of agents (e.g. beta-blockers) there are several levels of “wastebasket” codes -- the final, all-encompassing wastebasket here is Drug or biological substance/agent NOS, overdose/toxicity

Overdose/toxicity codes are to be used for drugs that have been used at an inappropriate dose or frequency, or in a recreational /non-prescription use setting.

Overdose codes:
Acetaminophen (tylenol, paracematol), overdose/toxicity Anesthetic gas, overdose/toxicity Anti-arrhythmic, overdose/toxicity Antibiotic/antimicrobial, overdose/toxicity Anticoagulant, overdose/toxicity Antidepressant drug NOS, overdose/toxicity Antineoplastic/chemotherapy or immunosuppressive drugs, overdose/toxicity Antiseizure drug NOS, overdose/toxicity Aspirin or other salicylate or NSAID, overdose/toxicity Benzodiazepine, overdose/toxicity Beta-blocker, overdose/toxicity Calcium channel blocker, overdose/toxicity Cardiac/cardiovascular drug NOS, overdose/toxicity Cocaine, overdose/toxicity Drug or biological substance/agent NOS, overdose/toxicity Hallucinogen, overdose/toxicity Hormone or hormone agonist NOS, overdose/toxicity Iatrogenic, complication of medical or surgical care NOS Insulin or other antidiabetes drug, overdose/toxicity Neuromuscular blocker/paralytic, overdose/toxicity Observation for SUSPECTED overdose Opioid/narcotic, overdose/toxicity Psychiatric drug NOS, overdose/toxicity Sedative or hypnotic, overdose/toxicity Thrombolytic drug, overdose/toxicity Tricyclic antidepressant, overdose/toxicity

For bad outcomes caused by drugs that had been used appropriately, in most cases a counterpart dx will exits in:

Adverse effect codes:
Acetaminophen (tylenol, paracematol), adverse effect Anesthetic gas, adverse effect Anti-arrhythmic, adverse effect Antibiotic/antimicrobial, adverse effect Anticoagulant, adverse effect Antidepressant drug NOS, adverse effect Antineoplastic/chemotherapy or immunosuppressive drugs, adverse effect Antiseizure drug NOS, adverse effect Aspirin or other salicylate or NSAID, adverse effect Benzodiazepine, adverse effect Beta-blocker, adverse effect Calcium channel blocker drug, adverse effect Cardiac/cardiovascular drug NOS, adverse effect Drug or biological substance/agent NOS, adverse effect Hallucinogen, adverse effect Hormone or hormone agonist drug, adverse effect Iatrogenic, complication of medical or surgical care NOS Insulin or antidiabetic drug, adverse effect Neuromuscular blocker/paralytic, adverse effect Opioid/narcotic, adverse effect Psychiatric drug NOS, adverse effect Sedative or hypnotic, adverse effect Thrombolytic drug, adverse effect Tricyclic antidepressant, adverse effect Xray contrast agent, adverse effect

how to use

People are admitted for an overdose for either of 2 possible scenarios:
- (1) Nothing bad has happened to them yet, but it may and so they're observed for observation. In this case, the primary admit code would be Observation for SUSPECTED overdose, and this should be combined with the specific drug(s) in the overdose -- and IF it was a suicide attempt than also combine with Suicide attempt
- (2) They HAVE dangerous physiologic manifestations already (e.g. resp failure, shock) and the admission is for that/those manifestations. In this case you should combine all the manifestations present + the overdose(s) and if relevant also Suicide attempt (intentional self-harm). And in this case, the PRIMARY (checked off) diagnosis is the ONE of the physiologic manifestations which is most responsible for the admission (i.e. "worst"; just like we do when people present with infection and multiple organ failures, we choose the worst manifestation as primary).

Coding substance related ICD10 diagnoses

See ICD10 Guideline for drugs and substances for more info on coding substance related ICD10 diagnoses.

@@ Line 31: / Line 31: @@
 ==== how to use ====
- {{DA| 1 template
+*People are admitted for an overdose for either of 2 possible scenarios:
-*Would appreciate some guidance in priorizing and picking a [[Dx Primary]] in some of these cases.
+**(1) Nothing bad has happened to them yet, but it may and so they're observed for observation.  In this case, the primary admit code would be [[Observation for SUSPECTED overdose]], and this should be combined with the specific drug(s) in the overdose -- and IF it was a suicide attempt than also combine with [[Suicide attempt (intentional self-harm)|Suicide attempt]]
-* For example, if the patient overdoses on multiple drugs (calcium channel blocker, Ace inhibitor, ETOH, ASA, Tylenol, Ramipril, etc.) and there are many diagnostic issues then how do we priorize this?
+**(2) They HAVE dangerous physiologic manifestations already (e.g. resp failure, shock) and the admission is for that/those manifestations.  In this case you should combine all the manifestations present + the overdose(s) and if relevant also [[Suicide attempt (intentional self-harm)]].  And in this case, the PRIMARY (checked off) diagnosis is the ONE of the physiologic manifestations which is most responsible for the admission (i.e. "worst"; just like we do when people present with infection and multiple organ failures, we choose the worst manifestation as primary).
-*Do we put the worst drug first? (ie. CCB)
-*Do we put the [[Suicide attempt (intentional self-harm)]] code first?
-** there is already an answer at that page that it should never be primary; for the same rationale, neither should be any of the overdose codes, but leaving details for Allan or Task.
-*Do we put the respiratory failure first?
-*Do we put the acidosis first?
-**Other issues:
-* Kidney failure
-* Aspiration pneumonitis
-* Electrolyte disturbances
-**Also when we list all the drugs one by one as overdoses should we use the same priority number for all of them? It is rarely clear the exact quantity of each drug so it is very difficult to know how to priorize this. }}
 {{ICD10 Guideline drugs and substances}}

Template:ICD10 Guideline overdose: Difference between revisions

Revision as of 09:32, 2019 October 10

Overdose/toxicity codes

how to use

Coding substance related ICD10 diagnoses

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