ICD10 Guideline for drugs and substances

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This page contains an ICD10 Coding Guideline for ICD10 collection. See ICD10 coding guidelines for similar pages.

Coding in ICD10 of Issues Related to Drugs and Substances

Introduction

  • This is a bit confusing because there are TWO DIMENSIONS to these ICD10 codes
    • (1) The type of agent/substance
    • (2) The category of medical problem related to the agent/substance
  • Not all categories of problems relate to all types of agents/substances

Regarding the type of agent/substance

  • The categories included are:
    • Psychoactive drugs/substances/agents -- these are substances of abuse, not pharmaceuticals. Includes: alcohol, opioids, sedative/hypnotics, cocaine, stimulants (including methamphetamine), hallucinogens (including hallucinogenic mushrooms), solvents + a "wastebasket" of "Psychoactive substance NOS"
    • Drugs/biologics -- these are specific pharmaceutical agents + a wastebasket of "Drug or biological substance/agent NOS"
    • Non-medicinal subtances -- these are toxins/poisons, including toxic alcohols( methanol, ethylene glycol, isopropyl alcohol), organic solvents, acids, metals, carbon monoxide, gases/fumes/vapors, pesticides, food poisoning, cyanide, venom from animals + a wastebasket of "Substances NOS"

Categories of medical problem and the agents to which they apply:

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  • overdose/poisoning" and "poisoning/toxic effect" -- These 2 seem to be similar, but they don't overlap because they apply to different agents.
    • overdose/poisoning is the term used in application to
    • poisoning/toxic effect is the term used in application to



To Clarify How Agent Type and Medical Problems Mix & Match

  • Regarding confusion between intoxication, acute vs. overdose/poisoning
    • Acute intoxication indicates just that. Being drunk is a good example of acute alcohol intoxication. These generally require just observation, not treatment.
    • On the other hand, an overdose/poisoning indicates that the patient either has a medical consequence, or is at high risk of getting one -- so that some medical treatment is given. These treatments might include: substance removal via activated charcoal, gastric lavage or dialysis; use of an antidote or neutralizing agent; life support if the overdose caused shock or respiratory failure; or others.
    • But clearly there can be some overlap. A common example is the drunk person who is felt in the ED to be "not protecting their airway" and so is intubated for this rationale. Because it is so difficult to judge the "need" for such things, the rule we will use to distinguish between them is to use intoxication, acute if no treatment is given, and to use overdose/poisoning if treatment is given.
  • Regarding confusion between withdrawal vs. chronic abuse/dependence/addiction
    • Withdrawal refers to the presence of withdrawal symptoms or signs.
    • Chronic abuse/dependence/addiction does not necessarily indicate that anything acute is currently occurring.
    • These 2 codes can be used together, if appropriate.
  • Regarding confusion between used appropriately, adverse effect (reaction, allergy, hypersensitivity) vs. overdose/poisoning
    • The difference here is that used appropriately refers to use of a pharmaceutical used in the correct dose. While if that drug is given or taken in excess amount, an overdose/poisoning can occur.
  • Regarding confusion between used appropriately, adverse effect (reaction, allergy, hypersensitivity) vs. intoxication, acute
    • These 2 codes can be used together, if a pharmaceutical is used in the correct dose, and that leads nonetheless to acute intoxication.


  • AG NOTES TO SELF:
    • Include here explanations distinguishing between the various types of codes: intoxication, acute; chronic abuse, dependence, addiction; withdrawal, AE used appropriately; overdose/poisoning.
    • Specially give guidelines for distinguishing acute intox vs. OD/poisoning; and acute vs. chronic
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This is an evil twin of Overdose vs used appropriately/adverse effect. This seems to be the healthier twin, though, so maybe it's the one we should keep, evil or otherwise. We'd need to reconcile the two and make sure the links are fixed. Allan, if you can make sure all the content of the twin is present in here and let me know then I will fix the links at the same time as linking all the other diagnoses to this page via Template:ICD10 Guideline drugs and substances.Ttenbergen 12:32, 2018 June 19 (CDT)

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