A patient with dementia, who is confined to a nursing home, was admitted to the hospital after falling from his wheelchair. The provider’s final diagnostic statement listed, “Toxic encephalopathy due to ciprofloxacin.” When queried, the provider confirmed that the antibiotic had been properly administered. We are confused by the note at G92, Toxic encephalopathy instructing to “Code first (T51-T65) to identify toxic agent.” Can code G92 be assigned along with the adverse effect T-code?
Yes. Since this is an adverse reaction to medication, assign code G92, Toxic encephalopathy, as the principal diagnosis. Assign code T36.8X5A, Adverse effect of other systemic antibiotics, initial encounter, as an additional diagnosis. The code first note is intended to provide sequencing guidance when coding toxic effects. However, the instructional note does not prohibit assigning code G92 along with adverse effect codes.