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Acute Alcohol Intoxication

Debra Posted Tue 28th of October, 2014 16:35:08 PM

When patient's present to the Emergency Room intoxicated with altered mental status or ALOC, they may receive services to rule out other possible conditions, e.g. IV hydration Labs, x-ray or head CT may be ordered while the patient is sleeping off the effects.

Coding Clinic, 3Q 1996 provides some direction regarding an unconscious patient in a coma due to alcohol as a Toxic effect of alcohol 980.0. What about the teenager who goes out partying not dependent or alcoholic but is brought to ED because he is altered?

The ED physician's at my facility are not comfortable or use to making a diagnosis of Alcohol Poisoning or Toxic Effect of ETOH in these type of patients. They feel that 305.00 for a nondependent alcohol intoxication should be principle.

From a medical emergency stand point and to meet the medical necessity for the tests that might be ordered the code of 305.00 does not adequately support the severity of the patient's condition.

Would the AMS or ALOC be reported first, alcohol poisoning or toxic effect of alcohol or alcohol abuse be first? When does it become a poisoning or overdose, does it depend on the blood alcohol level?

Your help is appreciated.

SuperCoder Answered Tue 28th of October, 2014 23:31:00 PM

I am dividing your question into two parts:

1) Coding Clinic, 3Q 1996 provides some direction regarding an unconscious patient in a coma due to alcohol as a Toxic effect of alcohol 980.0. What about the teenager who goes out partying not dependent or alcoholic but is brought to ED because he is altered?

The ED physician's at my facility are not comfortable or use to making a diagnosis of Alcohol Poisoning or Toxic Effect of ETOH in these type of patients. They feel that 305.00 for a nondependent alcohol intoxication should be principle.

Answer: Reporting 305.00 or 980.0 will depend upon the whether the patient has maladaptive effect of alcohol for which he is not dependent (305.00) or when he consumes excess alcohol in an apparent suicide attempt (980.0).

When a teenager who goes out partying not dependent or alcoholic but is brought to ED because he is altered you would use code 305.00.

2) Would the AMS or ALOC be reported first, alcohol poisoning or toxic effect of alcohol or alcohol abuse be first? When does it become a poisoning or overdose, does it depend on the blood alcohol level?
Answer: For first part you need to follow the ICD guideline of reporting etiology followed by symptom. Report first the alcohol poisoning or toxic effect of alcohol or alcohol abuse and then report AMS or ALOC.

See links below:

https://www.supercoder.com/coding-newsletters/my-emergency-medicine-coding-alert/icd-9-coding-ring-in-the-new-year-with-a-refresher-of-alcohol-related-diagnoses-109403-article

https://www.supercoder.com/coding-newsletters/my-emergency-medicine-coding-alert/poisoning-or-adverse-effect-of-a-drug-steers-diagnosis-coding-article

Thanks !!

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