#THERAPEUTIC DRUG MOINTIRING IVCD 10 CODE#

Regardless of my answer, how the coder interprets the record will supersede anything you or I can come up with, and that code assignment is somewhat subject to change based on the subjective tone and terms used by the physician in the admission note. Remember, though, that these types of questions are generally best left to your coders. You should also use an additional code to identify any pervious personal history or family history of neoplasms and or GI issues which might support the screening colonoscopy. In other words, they are not bringing in the patient with the sole objective of monitoring and bridging anticoagulation therapy the objective is the colonoscopy. This seems appropriate to me over Z51.81 as drug monitoring is not the goal of the episode of care, but rather a necessary step in order to accomplish the colonoscopy. If this truly is a screening colonoscopy, then the Z12.11 could be the principal diagnosis. You would also add the Z79.82 code for long term (current) use of antithrombotic/antiplatelet. Code 523.9, Unspecified gingival and periodontal disease, code V58.83, Encounter for therapeutic drug monitoring, and code V58.61, Long-term (current) use of anticoagulants, should be assigned as secondary diagnoses.Īpplying the rationale from Coding Clinic above, the reason for admission would be the condition for which the colonoscopy is being done. The dental condition required care, and the patient's medications had to be adjusted in preparation for the dental surgery. What should be the principal diagnosis in this case? The dental condition or V58.61 or V07.8?Īnswer: Assign code 521.09, Other dental caries, as the principal diagnosis. Every time her Coumadin is stopped, the patient's access clots.' It appears that the dental extraction would have been carried out as an outpatient if the patient had not had clotting problems. In addition, the history of present illness specifies, 'the primary reason for admission is not for her teeth extraction but because she has had chronic clotting problems of her vascular access for dialysis. The documentation states that the patient was admitted for anticoagulant adjustment prior to her surgery. This had to be stopped prior to her dental procedure and she needed to be switched to IV Heparin. She has been on Coumadin in the past for clotting of her dialysis access.

Question: A patient is admitted with severe dental caries and periodontal disease. Is that an appropriate principal diagnosis? The other option would be Z12.11, Encounter for screening for malignant neoplasm of colon).Ī: The last time this was addressed was in Coding Clinic, Third Quarter, 2002, p. The encounter is for heparin bridge and the closest code I can find is Z51.81, Encounter for therapeutic drug level monitoring. I’m having some trouble determining the principal diagnosis. The goal of TDM is to use appropriate concentrations of difficult-to-manage medications to optimize clinical outcomes in patients in various clinical situations.Q: I’m working on a case where a patient with atrial and mitral prosthetic heart valves on warfarin is being admitted for a heparin drip bridge prior to a colonoscopy. When interpreting concentration measurements, factors that need to be considered include the sampling time in relation to drug dose, dosage history, patient response, and the desired medicinal targets. TDM begins when the drug is first prescribed, and involves determining an initial dosage regimen appropriate for the clinical condition and such patient characteristics as age, weight, organ function, and concomitant drug therapy. The process of TDM is predicated on the assumption that there is a definable relationship between dose and plasma or blood drug concentration, and between concentration and therapeutic effects. It is unnecessary to employ TDM for the majority of medications, and it is used mainly for monitoring drugs with narrow therapeutic ranges, drugs with marked pharmacokinetic variability, medications for which target concentrations are difficult to monitor, and drugs known to cause therapeutic and adverse effects. Therapeutic drug monitoring (TDM) is the clinical practice of measuring specific drugs at designated intervals to maintain a constant concentration in a patient's bloodstream, thereby optimizing individual dosage regimens.

Therapeutic drug mointiring ivcd 10