by Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
February 15th, 2015
Underdosing is a clinical concept new to ICD-10. Underdosing identifies situations referring to the practice of a patient taking less medication as prescribed by a physician, or a physician prescribing less than what is prescribed by the manufacturer, resulting in poor patient outcomes.
Inappropriate prescribing by the physician
- Physician under prescribing with no justification
- Outdated patient's weight in the medical record can give incorrect weight-based dosage.
- Prescribing a reduced amount due to adverse affects
- Antibiotics given at a reduced or “renal dose” and not increased once renal function recovers.
Patient was prescribed medication to treat a condition and the patient was not compliant
Either deliberately or inadvertently, the patient did not take the medication as prescribed by their physician or took a reduced amount
36 YO Female came in complaining of sharp pains on the right side of her back. Patient was seen previously and treated for a UTI. Patient states she did not finish her medication (tetracycline), which resulted in pyelonephritis (Kidney infection).
Diagnosed as follows:
N10 - Acute tubulo-interstitial nephritis
This event triggered or was prolonged due to this circumstance
T36.4X6A - Underdosing of tetracyclines, initial
underdosing code assigned as secondary
The appropriate 7th character is to be added to each code from category T36
A - initial encounter
D - subsequent encounter
S - sequela