Poisonings vs. Adverse Reactions vs. Toxic Effects vs. Underdosing Definition

Poisoning: reaction to the improper use of a medication. This can include either:

Adverse Reaction: reaction when a substance is taken correctly as directed.

Toxic Effect: reaction or effect due to the exposure to a substance that is not a medication.

Underdosing: taking less of a medication, than a provider or manufacture’s instruction.

Coding Considerations:

T36-T50 code groupings correlate to Poisoning, Adverse Effects & Underdoing. T51-T65 code groupings correlate to Toxic Effects

Sequencing Guidance: 

Poisoning:

PDx will be poisoning code (T36-T50) with the manifestation(s) sequenced as a Secondary Diagnosis

Example:

Pt. presents with Acute Pulmonary edema due to accidental heroin overdose in a patient who is heroin dependent.

Adverse Reaction:

PDx will be the manifestation, symptom, or adverse effect followed by the appropriate code for the adverse effect of the drug (T36-T50)

Example:

Pt. presents with Toxic Encephalopathy from Digoxin toxicity. Upon questioning the pt. admits to taking the medication as prescribed.

Toxic Effect:

PDx will be the toxic effect code (T51-T65) with the manifestation(s) sequenced as a Secondary Diagnosis

Example:

Pt. presented with suicide attempt, drinking Drano. Admitted for erosive esophagitis with bleeding and blood pressure monitoring.

Underdosing:

The PDx will be the manifestation, symptoms, or adverse effect, followed by the appropriate code for the adverse effect of the drug (T36-T50)

Example:

Pt. presented with HTN urgency after stopping all their antihypertensive medications on their own.

Chronic conditions related to alcohol or drug abuse, or dependence are not classified as poisoning. The code for the chronic condition is sequenced first, followed by a code for the abuse or dependence. For example:

CDI Practice Considerations

Since sequencing and thus DRG assignment is determined by the circumstance of the event, always make sure the adverse reaction, poisoning, toxic effect, or underdosing is clearly documented along with the medication or other toxic substance and query, as necessary.

Overdoses are considered poisoning.

Drug Toxicity due to a medication is either an adverse effect or poisoning, NOT a toxic effect. Query if the documentation is not clear.

Common Manifestations to review and potentially query for:

Be aware of the reason, if known, for the underdosing. If related to financial hardship, this could map to Z91.190 Patient’s noncompliance with other medical treatment and regimen due to financial hardship, or Z91.A20 Caregivers intentional underdosing due to financial hardship, supporting capture of Social Determinants of Health code. Refer to Official Coding Guideline I.C.21.c.17 ‘Social Determinants of Health’ for additional guidance.

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