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MRCP 200 Diagnostic for Physicians ServicePortfolio Project Parts 1 & 2Kerry Gallego08/01/2018MRCP200 – Diagnostic Coding for Physician ServicesPortfolio Project Case Studies 1 –14Part 1:Scenario 1Chief Complaint:“My throat hurts and it hurts when I swallow.”History:Patient is a 10-year-old girl who comes to her pediatrician’s office with her mother complaining of a sore throat. She says she has had the sore throat for about two days. Her mother says this is unusual and that she has not had a sore throat for at least two years. She has not had her annual flu shot, which should have been administered about a month ago. Her mother says she has not had the time to get her in yet but has no reason not to have her daughter immunizedReview of Systems, Physical Exam, Laboratory Tests: Patient denies fever or chills, headache, earache, nasal congestion, cough, abdominal pain, or other symptoms. VS–BP 100/60; P 80; R 18; T 99.8. Throat is inflamed. Tonsils have white exudate. Mild cervical lymphadenopathy with minimal tenderness. Lungs clear to auscultation and palpation. Remainder of exam is unremarkable. Rapid strep test is positive.Provide the appropriate ICD-10-Code (s) for this scenario (List out diagnosis and provide code (s): First listed diagnosis J03.00 Acute Streptococcal Tonsillitis, unspecified.What procedure did the provider perform? (List, you do not need to code) Strep testWhat additional questions do you have for provider? N/AWhat additional documentation is needed? N/AScenario 2Chief Complaint:My neck hurts and I have a tingling pain sensation going down my right arm.History: Patient is a 68-year-old male with history of neck pain that has been worsening over the last two years. Recently he has experienced some numbness and a painful tingling sensation in his right arm going down to his thumb. No other symptoms or pertinent medical history.Review of Systems, Physical Exam and Tests:Review of systems is negative except for the neck pain and sensations in his right arm described above. No history of acute injury to neck or arm. Physical exam is normal except for neurological exam of theright upper extremity, which reveals slight decrease to sensation in the thumb and forefinger region of the hand in the C6 nerve root distribution. No evidence of weakness in the muscles of the arm or hand. MRI scan of the neck shows degenerative changes of the C5-6 disc with lateral protrusion of disc material. No other abnormalities noted. The patient is referred to a pain specialist for evaluation and treatment. Based on the above findings, the pain physician performs a cervical transforaminal injection at C5-6.1.Provide the appropriate ICD-10-Code (s) for this scenario (List out diagnosis and provide code (s): M50.122 Cervical due to disorder at C5-C6 level with radiculopathy. 2.What procedure did the provider perform? (List, you do not need to code) Cervical transforaminal injection at C5-63.What additional questions do you have for provider? N/A4.What additional documentation is needed? N/AScenario3Chief Complaint: “I was crossing the street and got hit by a car. My right leg is broken and my left wrist hurts.”History: Patient is a 24-year-old male brought to the Emergency Department after being struck by a car while crossing the street. He denies any previous medical diseases or surgical proceduresReview of Systems, Physical Examination and Tests: VSS, Physical Exam is within normal limits with the following exceptions: RLE–open fracture of the mid-shaft region of the femur. Wound is approximately 15 cm in length and the bone fragments show injury to bone and periosteum (Gustilo Type IIIB). At least three fragments are visible.No apparent nerve or vascular injuries are noted. LUE–skin intact over entire extremity. There is obvious deformity of the wrist, which is painful to palpation. Neurological and vascular exam of the hand is intact. X-rays: comminuted mid-shaft fracture of the right femur. There is a transverse fracture of the distal left radius just proximal to the wrist joint with dorsal displacement of the distal fragment (Colles’fracture). All other x-rays are normal.Hospital course:The patient was admitted to the hospital and taken directly to the operating room for initial treatment, including debridement and irrigation of the right splinting of the left wrist. On the second hospital day, the patient was again taken to the operating room for definitive treatment of the both fractures by open reduction and internal fixation (ORIF) techniques.Provide the appropriate ICD-10-Code (s) for this scenario (List out diagnosis and provide code (s): S72.351C Displaced comminuted fracture of right femur; S52.532A Colle’s fracture of left radius, initial encounter for closed fracture.What procedure did the provider perform? (List, you do not need to code) Physical exam and debridement and irrigation of the right open fracture and splinting of left wrist, and open reduction and internal fixation techniques.What additional questions do you have for provider? N/AWhat additional documentation is needed? N/AScenario 4Chief Complaint: Dizziness, weakness, and feeling tired last few days. He reports passing out at school.History: 20-year-old male college athlete with no prior medical history. On wrestling and cross country running team. Feeling dizzy, lightheaded, weak, and tired for the past two days. Had three several second witnessed syncopal episodes at school yesterday. Went to university clinic and wasReferred by nurse. Patient states no palpitations, no tachycardia, and no blurred vision noticed prior to each episode. Upon questioning, patient admitted he had to lose 11 lbs. to meet wrestling weight requirement. He accomplished this byingesting carbohydrates, minimal fluids, heavy exercise, and purging. No medication or allergies. Denies alcohol, drugs, supplements, or diuretics use.Exam Looks exhausted. No apparent distress. Afebrile. Orthostatic VS: Lying BP 116/78 with HR 56, Sitting BP 107/60 with HR 74, Standing BP 92/49 with HR 112 Mucus membranes pale, skin is dry, with turgor and tenting. Capillary refill is 2 - 3 seconds. Chest is clear. Heart sounds normal. Labs significant for creatinine (2.13), BUN (43), glucose (60). EKG shows sinus tachycardia Assessment and Plan Orthostatic intolerance. Dizziness, fatigue, and syncope likely secondary to hypotension, dehydration and hypovolemia. Provided fluid challenge of 2L IV NS in office today with improved condition post infusion including resolution of orthostasis and tachycardia. Ordered nutritional consult for dietary intake requirements, physical activity, and potential bulimia Recommended patient has a psychological consult for potential bulimia; stated he would think about it.Scheduled a follow-up in 2 weeks to ensure no further symptoms. Return earlier if symptoms persist. No driving until follow up appointment.1.Provide the appropriate ICD-10-Code (s) for this scenario (List out diagnosis and provide code (s): R00.0 Tachycardia, unspecified; I95.1 Orthodic hypotension; E86.0 Dehydration; E86.1 Hypovolemia; R55 Syncope and Collapse2.What additional questions do you have for provider? N/A3.What additional documentation is needed? N/AScenario 5Chief Complaint “My stomach hurts and I feel full of gas.”History 47-year-old male with Mid-abdominal epigastric pain, associated with severe nausea unable to keep down any food or liquid. Pain has become “severe” and constant. Has had an estimated 13-pound weight loss over the past month. Patient reports eating 12 sausages at the Sunday church breakfast five days ago which he believes initiated his symptoms. Patient admits to a history of alcohol dependence. Consuming 5 –6 beers per day now, down from 10 –12 per day 6 months ago. States that he has nausea and sweating with “the shakes” when he does not drink.Exam VS: T 99.8°F, otherwise normal. Mild jaundice noted. Abdomen distended and tender across upper abdomen. Guarding is present. Bowel sounds diminished in all four quadrants. Oral mucosa dry, chapped lips, decreased skin turgor.Assessment and Plan Dehydration and suspected acute pancreatitis. Admit to the hospital. Orders written and sent to on-call hospitalist. 1L IV NS started in office. Blood drawn for labs. Recommend behavioral health counseling for substance abuse assessment and possible treatment.Patient’s wife notified of plan; she will transport to hospital by private vehicle.Provide the appropriate ICD-10-Code (s) for this scenario (List out diagnosis and provide code (s): R10.13 Epigastric pain; R10.829 Abdominal tenderness, unspecified site; R17 Unspecified jaundice; E86.0 Dehydration; F10.20 Alcohol dependence, uncomplicatedWhat procedure did the provider perform? (List, you do not need to code) Physical exam, blood drawn for lab tests, and admit to hospitalWhat additional questions do you have for provider? N/AWhat additional documentation is needed? N/AScenario 6Chief Complaint Right earache and ear pain.History This 20-year-old male is an established patient and well known to me. He is a full-time college student, and presents with a right sided ear pain, noted 8/10. The symptoms started yesterday and continue to worsen with no pain relief using acetaminophen. Denies discharge, hearing loss, or ringing/roaring. He denies trauma or recent barotrauma to ear. He denies fever, sore throat, and cough today. He reports recently having an URI that resolved with OTC medications. He is up to date on his influenza, HPV, Tdap, and meningococcal immunizations. Patient does not use tobacco, alcohol, or illicit drugs. He denies exposure to second hand smoke. Medical history includes major depressive disorder with recurrent episodes of mild severity, and bipolar II disorder. His current medications include aripiprazole, and duloxetine. No known allergies.16-point review of systems negative except for notations above.Exam Healthy appearing male. A&Ox3. He appears calm and is cooperative. Vital signs: BP: 130/78 HR: 70 bpm T: 99.8 °F Wt.: 235 lbs. Ht: 5′ 10”. ENT: auricle and external canals normal bilaterally. Right ear: erythematous membrane, bulging, with loss of landmarks. Pharynx, teeth, and nose exam normal. No cervical adenopathy bilaterally. Integumentary: Skin is flushed, warm, and dry with no edema. Mucous membranes are moist. Respiratory: Lungs clear CTA with normal respiratory effort. Abdomen: non-tender, no organomegaly. Assessment and Plan New onset AOM AD, suppurative, with pain unrelieved by acetaminophen. Prescriptions: amoxicillin for AOM; ibuprofen for pain.Return in one week if symptoms persist.Provide the appropriate ICD-10-Code (s) for this scenario (List out diagnosis and provide code (s): H66.001 Acute suppurative otitis media without spontaneous rupture of ear drum, right earWhat additional questions do you have for provider? N/AWhat additional documentation is needed? N/AScenario7PREOPERATIVE DIAGNOSIS: Splenic hematoma.POSTOPERATIVE DIAGNOSIS: Same. PROCEDURE PERFORMED: Splenectomy. ANESTHESIA: General. PROCEDURE: A surgical technique was used to remove the spleen due to splenic hematoma following trauma in football game, kicked. The patient was given general anesthesia. The anesthesiologist inserted a temporary tube into the patient’s stomach to empty it. This helped to decompress the stomach and prevent postoperative nausea. A catheter was inserted into the bladder to drain the urine. Surgery was done with the patient lying flat on his back. Several small incisions were made into the abdomen. One was used for the laparoscope, which was attached to a camera that sent images to the video monitor. The other incisions were used to hold or manipulate tissue in the abdomen. Carbon dioxide gas is insufflated into the abdominal cavity to allow room to work and to allow visualizing the area. Parts of the spleen were freed from surrounding tissue. Blood vessels to the stomach and spleen were visualized, clipped with metal clips, and divided. Once the spleen was dissected free of its attachments in the abdominal cavity, it was placed in a special surgical plastic bag and removed through one of the small abdominal incisions. At the end of the surgery, carbon dioxide gas was removed. The small incisions were closed with suture, the skin cleaned, and the incisions covered with a small dressing. Patient tolerated the procedure well.1. Provide the appropriate ICD-10-Code (s) for this scenario (List out diagnosis and provide code (s): S36.092A Injury spleen contusion; W50.1XXA Accidental kick by another person, initial encounter; Y93.61 External cause, activity football2.What procedures did the patient have? Spleenectomy3.What additional questions do you have for provider? N/A4.What additional documentation is needed? N/AScenario 8OPERATIVE REPORT 1-85PREOPERATIVE DIAGNOSIS: Glaucoma, severe stage, open angle, right eye. POSTOPERATIVE DIAGNOSIS: Same. OPERATION PERFORMED: Sequential cyclocryotherapy, right eye. INDICATION: This 74-year-old white female has an out-of-control glaucoma in her right eye. She is pseudophakic and has been allergic to multiple drops and has had one sequential therapy before that worked quite well and then she stopped taking her drops. It is obvious that despite the cyclocryotherapy, she will need to continue the Pilocarpine. DESCRIPTION OF PROCEDURE: After the patient was placed on the OR table, she was given a retrobulbar anesthesia of Xylocaine 2% with 0.75% Marcaine and Wydase for a volume of 3.5 cc. After this, she was prepped and draped in the usual sterile fashion for ophthalmic surgery and a wire lid speculum was used to separate the lids of the right eye. 3.5 mm from the limbus was marked out with a marking pen in the superior temporal quadrant and the right inferior nasal quadrant of her eye. The cryoprobe was liquid nitrogen and nitrous oxide and was applied to ?80 for a 5-second treatment in a freeze-thaw-freeze triple row of cryotherapy laid down in both the defined quadrants. There were no complications. Maxitrol ointment, Telfa, and two pads were applied, and the patient sent to the Recovery Room.1. Provide the appropriate ICD-10-Code (s) for this scenario (List out diagnosis and provide code (s): H40.1113 Primary open-angle glaucoma, right eye, severe stage2.What procedure did the provider perform? (List, you do not need to code) Sequential cyclocryotherapy, right eye3.What additional questions do you have for provider? N/A4.What additional documentation is needed? N/AScenario 9 OPERATIVE REPORT, CESAREAN SECTION 1-90PATIENT: May Ann WilsonSURGEON: Shawn Martinez, MDPREOPERATIVE DIAGNOSIS: Intrauterine pregnancy, 39 weeks, previous cesarean section, and declined vaginal birth after cesarean. This patient has been seen by Dr. Martinez for the patient’s complete course of her pregnancy without complications and will continue with Dr. Martinezfor her post-partum care.POSTOPERATIVE DIAGNOSIS: Intrauterine pregnancy, 39 weeks, previous cesarean section, and declined vaginal birth after cesarean.PROCEDURE: Repeat low transverse cervical segment cesarean section.ANESTHESIA: SpinalCOMPLICATIONS: NoneFINDINGS: Viable male infant weighing 9pounds 12.5 ounces, with Apgars of 9 at 1 minute and 10 at 5 minutes.PROCEDURE: The patient was prepped and draped in the supine position with left lateral displacement of the uterine fundus under spinal anesthesia with a Foley catheter indwelling. A transverse incision was made in the lower abdomen, removing the old scar. The fascia was divided laterally. The rectus muscle was divided in the midline. The peritoneum was entered in the sharp manner. An incision was extended vertically. The bladder flap was created using sharp and blunt dissection and reflected inferiorly. The uterus was entered in a sharp manner in the lower uterine segment, and the incision was extended laterally with blunt traction. The amniotic fluid was clear. The infant’s head was delivered. The infant was then delivered, and bulb suctioned while the cord was being doubly clamped and divided. The infant was given to the intensive care nursery staff in apparent good condition. The placenta was manually expressed. The uterus was delivered from the abdominal cavity and placed on wet lap sponges. A dry sponge was used to ensure remaining products of conception were removed. The cervical os (opening) was ensured patent with a ring forceps. The uterine incision was closed with 0 Vicryl interlocking suture in two layers, with the second layer imbricating the first. A figure-of-eight suture was also placed, which was required for hemostasis. The operative site was irrigated. The bladder flap was reapproximated using 2-0 Vicryl continuous suture. The tubes and ovaries appeared normal bilaterally. The uterus was placed back within the abdominal cavity. The pelvic gutters were irrigated. The anterior peritoneum was reapproximated using 2-0 Vicryl continuous suture. The incision was irrigated. The fascia was closed with 0 Vicryl continuous suture. The incision was irrigated. The skin was closed with staples. All sponges and needles were accounted for at the completion of the procedure. The patient left the operating room in apparent good condition, having tolerated the procedure well. The Foley catheter was patent and draining clear yellow urine at the completion of the procedure.1.Provide the appropriate ICD-10-Code (s) for this scenario (List out diagnosis and provide code (s): O34.21 Previous cesarean delivery; O75.82 Onset labor 37 weeks, with delivery by (planned) cesarean section.2.What procedure did the provider perform? (List, you do not need to code) Repeat low traverse cervical segment cesarean section.3.What additional questions do you have for provider? N/A4.What additional documentation is needed? N/AScenario 10Operative Report –Medical Report 14.11PREOPERATIVE DIAGNOSIS: Malignant MelanomaPOSTOPERATIVE DIAGNOSIS: Malignant Melanoma, pathology pendingPROCEDURE PERFORMED: Wide Excision of MelanomaANESTHESIA: GeneralNo ComplicationsINDICATIONS: The patient is a 48-year-old female who had quite a bit of sun exposure throughout her lifetime. A suspicious-looking area was noted on her back and this was biopsied. The provided to be malignant melanoma and, therefore, she was referred to me for wide-excision. Informed consent was obtained.PROCEDURE IN DETAIL: The patient was brought into the operating room suite and placed in supine position. General endotracheal anesthesia was instituted without difficulty. The patient was then flipped into prone position and her back was prepped and draped in the usual sterile manner. The patient had preoperatively been marked with 1-cm margins around this entire malignant melanoma. Using a #15 blade, an incision was made in the back on the preoperative marks to obtain wide excision. Using the Bovie cautery for homeostasis, dissection was carried down all the way to the fascia, and the entire skin mass was removed, which totaled about 3 x 3 cm in size.The superior aspect of the mass was removed with a short suture, and the lateral aspect was marked with a long suture. The specimen was then sent off to pathology.The deep layer was closed using Vicryl. The skin edges were closed using a running 3-0 nylon. Sterile dressing was applied after injecting the surrounding area with 0.25% Marcaine with epinephrine. General endotracheal anesthesia was reversed without any complications, and the patient was taken to the recovery room in stable condition.Provide the appropriate ICD-10-Code (s) for this scenario (List out Diagnosis and provide code (s): C43.59 Malignant melanoma of other part of trunk.What procedures did the patient have? Wide excision of melanomaWhat additional questions do you have for provider? Results pending, pathology report needed.What additional documentation is needed? N/AScenario 1167-year-old male is taken to the emergency room with severe chest pain. The physician provided an expanded problem-focused history and examination. While the physician is examining the patient, his pressure drops, and he goes into cardiac arrest. Cardiopulmonary resuscitation is given to the patient, and his pressure returns to normal; he is transferred to the intensive care unit in critical condition. The medical decision making was of low complexity.1.Provide the appropriate ICD-10-Code (s) for this scenario (List out diagnosis and provide code (s): R07.89 Other chest pain; I46.9 Cardiac arrest, cause unspecified.2.What procedure did the provider perform? (List, you do not need to code) Expanded problem focused history and exam, cardiac resuscitation.3.What additional questions do you have for provider? Is the patient still in intensive care?4.What additional documentation is needed? Patient report after transfer to intensive care unit.Scenario 12Patient has been HIV positive for several years and lesions are suspicious for Kaposi's sarcoma. Pathology of biopsy confirmed HIV-related Kaposi's sarcoma.1. Provide the appropriate ICD-10-Code (s) for this scenario (List out diagnosis and provide code (s): B20 Human Immunodeficiency Virus (HIV) Disease; C46.0 Kaposi’s sarcoma of skin.2. What additional questions do you have for provider? Excision of skin, diagnostic. 3.What additional documentation is needed? N/AScenario 13OP NOTEPREOPERATIVE DIAGNOSIS: Deviated septumPROCEDURES PERFORMED 1. Septoplasty.2. Resection of inferior turbinate’s’.LOCATION: Outpatient hospitalThe patient was taken to the operating room and placed under general anesthesia. The fracture of the inferior turbinates was first performed to do the septoplasty. Once this was done, the septoplasty was completed, and the turbinates were placed back in their original positions. The patient was taken to recovery in satisfactory condition.1. Provide the appropriate ICD-10-Code (s) for this scenario (List out diagnosis and provide code (s): J34.2 Deviated nasal septum2. What procedure did the provider perform? (List, you do not need to code) Septoplasty, resection of inferior turbinate. 3. What additional questions do you have for provider? Is there external cause information in relation to this diagnosis?4.What additional documentation is needed? N/AScenario 14PROCEDURE NOTE: Caleb is in for a vasectomy, having undergone counseling earlier today. Informed consent was signed. Patient was given a pre-procedure 5mg Valium to ease possible anxiety. Patientwas placed in a supine position, and the scrotal area was shaved. Under sterile technique, the scrotal area was prepped with Betadine, and sterile drapes were applied. The right vas was localized and under sterile technique was infiltrated with 1% Xylocaine. The vas was externalized, and a 1.5-cm portion of the tube was removed. Proximal and distal stumps were doubly ligated with 4-0 silk. There was a small blood vessel in the skin that was oozing and was clamped. Attention was directed to the left side, where a similar procedure was performed. With hemostasis intact, the proximal and distal stumps on the leftwere retracted into the scrotum, and attention was directed to the right side, where there was slight oozing from the skin edge; with pressure, this did resolve, and them proximal and distal stumps were retracted into the scrotum.ASSESSMENT: VasectomyPLAN: The patient had been given the post-vasectomy instruction sheet, and Bacitracin and a gauze dressing were applied. Caleb is to apply antibiotics a couple of times a day with gauze, and he was given an instruction sheet to have sperm counts done no later than 8 weeks, and to take contraceptive precautions in the meantime.1.Provide the appropriate ICD-10-Code (s) for this scenario (List out diagnosis and provide code (s): Z98.52 Vasectomy status; Z71.89 Other specified counseling.2.What procedure did the provider perform? (List, you do not need to code) Vasectomy3.What additional questions do you have for provider? N/A4.What additional documentation is needed? N/APart 2 – Essays:Evaluate and explain the purpose and the function of the Neoplasm Table:The Table of Neoplasms, in the Alphabetic Index, lists the codes for neoplasms by anatomical site. For each site, there are six columns of codes identifying whether the neoplasm is malignant, benign, in situ, uncertain or unspecified behavior. The AHIMA staff stated that the Neoplasm Table includes the nature and status (primary, secondary, in situ) for malignancies, complications codes related to neoplasms, the stage of benign neoplasms and codes for reactions to chemotherapy. A neoplasm is a new and abnormal growth of tissue in some part of the body, especially as a characteristic of cancer. The types of neoplasms are: ? Benign (not harmful or malignant) tumors (cancer) which include uterine fibroids, osteophytes and melanocytic nevi (skin moles). ... ? Potentially (Possibly harmful) -malignant neoplasms which include carcinoma in situ. ... ? Malignant (virulent or infectious) neoplasms are commonly called cancer…The most common forms of neoplasms are breast, lung, colorectal, prostate, bladder. lymphoma, melanoma, and non-melanoma (skin). According to what the National Cancer Institute states,” the Cancer incidence and mortality statistics reported by the American Cancer Society and other resources were used to create the list. To qualify as a common cancer for the list, the estimated annual incidence for 2018 had to be 40,000 cases or more.” Most of all the benign and all the malignant neoplasm codes are found in chapter 2 of the ICD-10-CM which includes guideline on how to code them. To properly code the neoplasm the coder must have documentation showing whether the neoplasm is benign, malignant, in situ or uncertain behavior. The Alphabetic index shows a neoplasm table that corresponds with the terminology. If a histological term is documented, the term should be referenced first rather then going straight to the neoplasm first, so you can determine which column is appropriate to code. The Neoplasm Table is appropriate for other types of adenomas (a benign tumor formed from glandular structures in epithelial tissue) with the indication to “see Neoplasm, benign, by site” at the beginning of the listing and with other terms. The Neoplasm Table provides the proper code based on the type of neoplasm and the site. The guidelines also provide information regarding sequencing of neoplasms. The 2012 ICD-10-CM Official Guidelines for Coding and Reporting also address coding and sequencing of malignancies, of complications associated with the malignancies, or with the therapy thereof are subject to specific guidelines. The function and purpose of the Neoplasm Table is a list to code what type of neoplasm a person has and to help with coding for billing and reimbursement purposes. The table also show what type and category the neoplasm is listed under to retrieve the codes. The remainder of the index should be consulted where guidance is given to the appropriate column for each morphological (histological) variety listed.References: Evaluate and explain the purpose and function of the Table of Drugs and Chemicals:The Table of Drugs and Chemicals includes over 4,500 listings. Each listing may be present in one of six columns that further defines how a drug or chemical may have been used or misused. The six columns are poisoning accidental (unintentional), poisoning intentional self-harm, poisoning assault, poisoning undetermined, adverse effects and under-dosing (condition which has relapsed or exacerbated, for which the Rx was prescribed). This table contains a classification of drugs and other chemical substances to identify poisoning states and external causes of adverse effects. Each of the listed substances in the table is assigned a code according to the poisoning classification (960-989). These codes are used when there is a statement of poisoning, overdose, wrong substance given or taken, or intoxication. The table also contains a listing of external causes of adverse effects. An adverse effect is a pathologic manifestation due to ingestion or exposure to drugs or other chemical substances. he adverse effect is to be identified by the appropriate code found in Section 1, Index to Diseases and Injuries. An external cause code can then be used to identify the circumstances involved.The definitions of the six columns are as follows: Accidental poisoning (E850-E869) accidental overdose of drug, wrong substance given or taken, drug taken inadvertently, accidents in the usage of drugs and biologicals in medical and surgical procedures, and to show external causes of poisonings classifiable to 980-989.Therapeutic use (E930-E949) a correct substance properly administered in therapeutic or prophylactic dosage as the external cause of adverse effects.suicide attempt (E950-E952) instances in which self-inflicted injuries or poisonings are involved.Assault (E961-E962) injury or poisoning inflicted by another person with the intent to injure or kill.Undetermined (E980-E982) to be used when the intent of the poisoning or injury cannot be determined whether it was intentional or accidental.The American Hospital Formulary Service (AHFS) list numbers are included in the table to help classify new drugs not identified in the table by name. The Table of Drugs and Chemical contains a classification of drugs and other chemical substances to identify poisoning states and the external causes of adverse effects. These codes are used when there is a statement of poisoning, overdose, wrong substance given or taken, or intoxication of a person so coders can look up the correct code for billing and reimbursement purposes. References: ................
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