Drug Overdoses on the Rise as Top 10 Diagnoses Unveiled

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Original story posted on: August 2, 2021

Overdose deaths up 29 percent over last year.

Overdose deaths have been in the news frequently this month. Last year’s overdose deaths in the U.S. numbered 93,000, marking an increase of 29 percent over the previous year’s total of 72,000. The significant drugs involved include heroin and fentanyl.  

Centers for Disease Control and Prevention (CDC) data suggests that fentanyl is involved in 60 percent of the overdose deaths. According to the CDC, there were fewer than 7,200 overdose deaths in 1970, at the height of the heroin epidemic, and approximately 9,000 overdose deaths in 1988, when the crack cocaine epidemic was unfolding. There is no expectation that there will be a decrease in these numbers anytime soon.

The code assignment for these overdoses is found in the ICD-10-CM Table of Drugs and Chemicals:

Drug

ICD-10-CM Code

Description

Fentanyl

T40.411

Accidental

 

T40.412

Intentional

 

T40.413

Assault

 

T40.414

Undetermined

 

T40.415

Adverse Effect

 

T40.416

Underdosing

Heroin

T40.1X1

Accidental

 

T40.1X2

Intentional

 

T40.1X3

Assault

 

T40.1X4

Undetermined

   

There is no option for adverse effect or underdosing for heroin, as this drug is not prescribed for patients.

The seventh characters of A (initial encounter), D (subsequent encounter), and S (sequela) are applicable to all the above identified codes. 

The Monitor Mondays Listeners Survey for July 20 asked listeners if they had noticed an increase in overdose deaths in their area. There was an affirmative response by 34 percent of poll participants. The remainder of the audience had not noticed a change or preferred not to answer.

It should be noted that for anyone needing assistance for substance abuse, the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline is 1-800-662-HELP (4357).

At least tangentially related, as substance abuse often gives way to numerous other health conditions, the Healthcare Cost and Utilization Project (HCUP) published an article this month regarding the most frequent principal diagnoses. The data is from 2018, and does not include deliveries and neonatal inpatient stays.

The most common principal diagnosis was septicemia, which accounted for 8 percent of inpatient stays, with a mean cost of $18,700. Heart failure was second, with 4.1 percent of cases and a mean cost of $12,800. The third-most common principal diagnosis (and second-costliest) was osteoarthritis, with a mean cost of $16,000. The remainder of the top 10 diagnoses include:

4.      Pneumonia (except caused by tuberculosis);
5.      Diabetes with complication;
6.      Acute myocardial infarction;
7.      Cardiac dysrhythmias;
8.      Chronic obstructive pulmonary disease (COPD) and bronchiectasis;
9.      Acute and unspecified renal failure; and
10.     Cerebral infarction.

Many of these diagnoses are targeted for denials by payors. Here are some thoughts regarding them; first, for septicemia, ensure that the patient meets criteria for sepsis, and that the documentation paints a picture of a severely ill patient. For heart failure, review the case for a chest X-ray that shows heart failure, pulmonary edema, or congestion, and also that the patient was treated with intravenous diuretics. Osteoarthritis seems to be straightforward, especially if the patient has surgery. In the coming year, the physician will need to document the patient’s full clinical presentation if he or she wants to admit a patient as an inpatient to the hospital.  

It is important that the clinical documentation tells the patient’s complete story. The story should include why the patient is at the facility, what the concurrent problems that are still under treatment are, and what treatment occurred during the visit to the facility.

Programming Note: Listen to Laurie Johnson and the Talk Ten Tuesdays Coding Report, Tuesday on Talk Ten Tuesdays, 10 Eastern.

Laurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS Trainer

Laurie M. Johnson, MS, RHIA, FAHIMA, AHIMA Approved ICD-10-CM/PCS Trainer is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an American Health Information Management Association (AHIMA) approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and makes frequent appearances on Talk Ten Tuesdays.

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