Health Information Management

Q&A: Respiratory failure as a result of an overdose

CDI Strategies, April 28, 2016

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Q: When a patient does presents in acute respiratory failure, as well as overdose, is it ever appropriate to assign the acute respiratory failure as principle diagnosis as it is an acute condition that would have occasioned the admission to the hospital?
Many times it is a manifestation of the aspiration pneumonia that results from the overdose event – and our team members want to apply “it’s a direct manifestation of the aspiration pneumonia, not the overdose” in order to capture the ventilation procedure. And others state it is all a domino effect from the overdose regardless and the poisoning guidelines sequencing rule would still apply.
A: I remember, as a new CDI specialist, working my hardest to try to capture that ventilation time for these patients. Unfortunately, this is an example where the coding conventions and Official Guidelines for Coding and Reporting guidelines don’t necessarily reflect the clinical situation.
The Guidelines related to poisoning are very clear: We must code first the poisoning followed by the manifestations. In the example you provide, the aspiration and the respiratory failure are both considered a manifestation of the poisoning. Thus the poisoning must be sequenced first.
See Chapter 19, Section e, Section 5b, which states:
(b) Poisoning When coding a poisoning or reaction to the improper use of a medication (e.g., overdose, wrong substance given or taken in error, wrong route of administration), first assign the appropriate code from categories T36-T50. The poisoning codes have an associated intent as their 5th or 6th character (accidental, intentional self-harm, assault and undetermined. Use additional code(s) for all manifestations of poisonings.
Although it can be frustrating, we must follow the guidelines as written.
Editor’s Note: This Q&A is a follow-up discussion from one published in the March 30 edition of CDI Strategies. Laurie L. Prescott, RN, MSN, CCDS, CDIP, AHIMA Approved ICD-10-CM/PCS Trainer, and CDI Education Director at HCPro in Danvers, Massachusetts, answered this question. Contact her at For information regarding CDI Boot Camps visit

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