Underdosing - a New Clinical Concept in ICD-10 codes T36 - T50

T36-T50 Poisoning by, adverse effects of and underdosing of drugs, medicaments and biological substances (T36-T50)

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.

Examples:

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• Outdated patient's weight in the medical record can give incorrect weight-based dosage.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

Coding example:

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:

The appropriate 7th character is to be added to each code from category T36

A - initial encounter
D - subsequent encounter
S - sequela

Modern Medicine:
http://formularyjournal.modernmedicine.com/formulary-journal/content/tags/outcomes/medication-underdosing-and-underprescribing-important-issues?page=full

AmeriHealth:
http://provcomm.amerihealth.com/ProvComm/ProvComm.nsf/97a31cd29b5fe42d8525796500622a04/7664d49c87ecc1e185257a28005e33a2!OpenDocument

Find-A-Code.com:
http://www.findacode.com/code-set.php?set=ICD10CM&i=28531

More Items in January 2015

• Jan 30, 2015
  PQRS CMS.gov Interactive Timeline - Don't Miss the Deadlines!
• Jan 30, 2015
  CMS Opt-Out Regulations and Guidelines
• Jan 28, 2015
  Value Set Authority Center (VSAC)
• Jan 27, 2015
  Medicare to Change How it Pays Doctors and Hospitals
• Jan 23, 2015
  New: 2015 January Edition of the Medicare Quarterly Provider Compliance Newsletter
• Jan 23, 2015
  Eligible Professional 2014 Attestation Deadline on February 28; Prepare for Attestation
• Jan 14, 2015
  Billing for Split Unit of Blood
• Jan 14, 2015
  Aligning the Way Providers are Paid to Reward Value Rather than Volume (Value Based Modifiers)
• Jan 14, 2015
  What is an LMRP and Where Can I Find Them?
• Jan 06, 2015
  Holding of 2015 Date-of-Service Claims for Services Paid Under the 2015 Medicare Physician Fee Schedule
• Jan 06, 2015
  Modifier -59 Could Impact Your Reimbursement - New Coding Requirements!

To view more items select a month from our "Items by Month" list.

Or view documentation, coding and billing articles.