Alicia: We’re going to go ahead and start on our slides, getting to the meaty stuff. This is what you’re waiting for I know. Now that we’ve gotten to know you a little bit, I get the first slide, and these come from questions primarily that come to our forum. Sylvia takes care of that, she goes through those and puts this up.

Here's one that came through recently. The question came in:

Q: A patient with upper respiratory infection is prescribed penicillin. She returns 5 days later with pruritus of scalp following ingestion of penicillin prescribed and taken correctly. Please explain whether to choose A or S for 7th character on the adverse effect code? Would it always be an S for any code in the Adverse Effect column?

Medical Coding and Billing | Adverse Effect in ICD 10 CM – Video

A: Let’s look at the answer here, let me change screens. Repeating the question, she wants to know if we’re going to choose an A or an S, but actually it’s not going to be either one. Let’s look at this as a test question format. We know that the patient is here for a subsequent visit for the adverse effect of the scalp. The prescription was given correctly, and it just so happens that now they’re going to be allergic to penicillin.

So our first code is for the pruritus and that is going to be L29.8, and then our second code is the adverse effect, the prescription taken correctly (that’s very important) – you know the correct prescription was prescribed and it was taken correctly. So, an “A” stands for the initial visit. The “D” stands for the subsequent visit and the “S” stands for sequela or late effect.

Now, what we’ve got here is: Look at the ICD-10-CM Table of Drugs and Chemicals/ Penicillin/ Adverse Effect which is T36.0X5 (the X is your placement), with the 7th digit being D, for a subsequent encounter for the problem of the pruritus.

Let’s look at the code in detail: Adverse effect of penicillins, subsequent encounter – and that’s also abbreviated as PCN sometimes. And what this excludes: The appropriate 7th character for this is going to be D (subsequent encounter) because it’s the second visit; it’s not the initial time they came in for the pruritus, it’s the second time.

We have our: A – initial encounter, D – subsequent encounter, S – sequela. This is not the first time our patient is being seen for the pruritus. It is actually a followup visit, the second time the patient is being seen for the pruritus that was caused by the penicillin reaction.

And then S (sequela); this isn’t a sequela, it’s not really a late effect. What we’re having here is a subsequent encounter for the pruritus. Why did they have the pruritus? They have the pruritus because of the reaction to the penicillin. So “D” is the correct

[Ed. Note: seventh character}. And just like we have in the test question, the answer would be “B” the first listed is why they’re being seen, the pruritus, and then your T36 tells us this is a reaction to the penicillin and a 5 with D being the last character for this code.

Very good, OK! Now going on to our next slide…

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About the Author:

Alicia has been working in the medical field for over 20 years. She first learned about medical coding while working in a medical records department at a resort town hospital near where she was raised. Through the years she has held several jobs in the medical field from, CNA, EMT, Pharmacy technician and Medial Records Abstractor and Analyst. Outside of the medical field she has worked as a Real Estate agent, and owned her own on-line retail business. The medical field has always been where she felt the most comfortable. Alicia has taught medical coding, billing and medical law and ethics at a private college. She also did contract work in HCC Risk Adjustment and discovered she really enjoyed ICD work. Because she loves to learn Alicia is working towards her Masters in Health Care Administration with an emphasis on education. Having taken many online classes through the years to complete her degree she feels very comfortable with both face to face and on-line learning. Alicia will tell you that not only does she love medical coding but she has a passion for teaching it. Alicia lives in the middle of Texas with her husband who is a Pastor, five of her six children, three dogs and two cats.

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