how do i code statin drug intolerance for icd ?

by Ms. Georgiana Sawayn 4 min read

  • Ans – E78.5 (Hyperlipidemia, unspecified)
  • Z88.8 (Allergy to statin or intolerance to statin) Q.2 Patient present in ED with muscle pain and physician-diagnosed myopathy due to statin. The physician has advised stopping statin and monitor.
  • Ans – G72.0 (Drug-induced myopathy)
  • T46.6X5A (adverse effect of statin) (Rational- Physician has provided treatment for myopathy due to statin due to which we should code G72.0 and T46.6X5A and we should not code status ...

ICD-10-CM for Statin Intolerance
  • Cardio403.
  • Dec 14, 2017.
Dec 14, 2017

Full Answer

What is the code for statin intolerance?

The name of few statins are atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin and simvastatin. -If a physician has documented patient is intolerant to statin and no management is provided related to statin intolerance in such a case we should code the status code i.e allergy of statin (Z88.8).

How do you exclude statins from the ICD 10?

Members who remained on a high-intensity or moderate-intensity statin medication for at least 80 percent of the treatment period Patients who are unable to tolerate statins can be excluded from the measure by documenting the reason for intolerance and submitting the corresponding condition as an ICD-10 code on a claim.

What does it mean to have statin intolerance?

Statin intolerance is a clinical syndrome that is: 1) characterized by inability to use statins for long-term reduction of lipids and/or cardiovascular risk because of significant symptoms and/or biomarker abnormalities that can be temporally attributed to the initiation or dose escalation of statins; if appropriate,...

What is the ICD 10 code for myalgia due to statin?

Myalgia due to statin ICD-10-CM T46.6X5A is grouped within Diagnostic Related Group (s) (MS-DRG v38.0): 791 Prematurity with major problems 793 Full term neonate with major problems

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What is the ICD-10 code for statin?

Long term (current) use of antithrombotics/antiplatelets The 2022 edition of ICD-10-CM Z79. 02 became effective on October 1, 2021. This is the American ICD-10-CM version of Z79.

What is the ICD-10 code for atorvastatin Allergy?

6X5A: Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, initial encounter.

What is the ICD-10 code for statin induced myalgia?

0: Drug-induced myopathy.

What is statin intolerance?

As the name suggests, statin intolerance occurs when a patient is unable to continue to use a statin, either because of the development of a side effect or because of evidence on a blood test that certain markers of liver function or muscle function (creatine kinase) are sufficiently abnormal to cause concern. 2.

What is the ICD-10 code for allergic reaction to medication?

ICD-10 code Z88. 8 for Allergy status to other drugs, medicaments and biological substances is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .

What is the diagnostic code for drugs and medication Allergy?

8: Personal history of allergy to other drugs, medicaments and biological substances.

What is the ICD-10 code for drug-induced myopathy?

ICD-10 code G72. 0 for Drug-induced myopathy is a medical classification as listed by WHO under the range - Diseases of the nervous system .

What is R53 83?

ICD-9 Code Transition: 780.79 Code R53. 83 is the diagnosis code used for Other Fatigue. It is a condition marked by drowsiness and an unusual lack of energy and mental alertness. It can be caused by many things, including illness, injury, or drugs.

What is drug-induced myopathy?

A drug-induced, or toxic, myopathy is defined as the acute or subacute manifestation of myopathic symptoms such as muscle weakness, myalgia, creatine kinase elevation, or myoglobinuria that can occur in patients without muscle disease when they are exposed to certain drugs.

How do you address statin intolerance?

Treating Statin Intolerance If testing determines that there are no dangerous health implications aside from muscle pain, they may suggest supplements. Taking vitamin D or Q10 supplements may improve your muscle health and alleviate the pain you feel from taking statins.

What to do if patient Cannot tolerate statins?

In patients with statin intolerance, it may be advisable to change the dose, switch to a different statin, or try an alternate-day regimen. If intolerance is associated with all statins—even at the lowest dose—non-statin drugs and certain nutraceuticals can be considered.

How do you manage statin intolerance?

Statin intolerance has been effectively managed either by the use of alternate-day statin regimen with longer half lives like atorvastatin and rosuvastatin, combination of statins with non-statins, dietary interventions, or by specific pharmacotherapies.

What are the symptoms of statin toxicity?

These can present as myalgia, myopathy, myositis with elevated CK (creatinine kinase), or at its most severe, rhabdomyolysis, with some people reporting additional joint and abdominal pain.

What digestive problems can statins cause?

digestive system problems, such as constipation, diarrhoea, indigestion or farting. muscle pain.

What are the most common side effects of statins?

What are statin side effects?Muscle pain and damage. One of the most common complaints of people taking statins is muscle pain. ... Liver damage. Occasionally, statin use could cause an increase in the level of enzymes that signal liver inflammation. ... Increased blood sugar or type 2 diabetes. ... Neurological side effects.

What are the symptoms of statin myopathy?

Symptoms of statin induced myopathy include fatigue, muscle pain, muscle tenderness, muscle weakness, nocturnal cramping, and tendon pain. The muscle symptoms tend to be proximal, generalised, and worse with exercise.

What is T46 poisoning?

T46- Poisoning by , adverse effect of and underdosing of agents primarily affecting the cardiovascular system

What is the secondary code for Chapter 20?

Use secondary code (s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause code. Type 1 Excludes.

What is the difference between drug allergy and intolerance?

Intolerance. An allergic reaction occurs when the immune system overreacts to a harmless substance, such as a drug, which triggers an allergic response. Intolerances to drugs may produce similar symptoms, but do not involve the immune system.

What is code in medicine?

Code the underlying treated condition that necessitates the drug.

What are the symptoms of an allergic reaction to a drug?

Symptoms of allergic drug reactions may include: Constriction of the airways and wheezing or breathing difficulties, tightness in chest. Fainting, dizziness, confusion, or weakness. Fall in blood pressure, sometimes to dangerously low levels. Fever.

What are the side effects of coding?

Swelling of tissues (in the face, tongue, lips and/or throat), which can impact breathing and swallowing. Tachycardia. Weak pulse, paleness. Vomiting. When coding an adverse effect for a drug that was correctly prescribed and properly administered: Code for the side effect of the drug (e.g., diarrhea);

Why is it important to teach patients the difference between true allergic reactions to drugs and anticipated adverse effects to drugs?

It’s extremely important to teach patients the difference between true allergic reactions to drugs and anticipated adverse effects to drugs because treatment decisions could be affected. When patients are able to accurately describe their symptoms, physicians are better equipped to improve health outcomes and generate quality data ...

What are the contraindications for statins?

Documentation that the patient is on a statin medication or has documentation of a valid contraindication or exception to statin medications; contraindications/exceptions that can be defined by diagnosis codes include pregnancy during the measurement period, active liver disease, rhabdomyolysis, end stage renal disease on dialysis and heart failure; provider documented contraindications/exceptions include breastfeeding during the measurement period, woman of child-bearing age not actively taking birth control, allergy to statin, drug interaction (hiv protease inhibitors, nefazodone, cyclosporine, gemfibrozil, and danazol) and intolerance ( with supporting documentation of trying a statin at least once within the last 5 years or diagnosis codes for myostitis or toxic myopathy related to drugs)

What is a modifier in HCPCS level 2?

In HCPCS Level II, modifiers are composed of two alpha or alphanumeric characters.

What is the code for 2021?

Procedures/Professional Services (Temporary Codes) G9507 is a valid 2021 HCPCS code for Documentation that the patient is on a statin medication or has documentation of a valid contraindication or exception to statin medications; contraindications/exceptions that can be defined by diagnosis codes include pregnancy during the measurement period, ...

How to test for statin side effects?

conduct genetic tests to see if you are genetically prone to side effects from statins. conduct a muscle biopsy to remove a small amount of muscle for testing. require a symptom questionnaire, where you describe your symptoms. conduct a muscle strength test to evaluate the strength of your muscles.

What is the most common side effect of statins?

There are different symptoms you may experience. The most common is muscle pains or cramps, also called myalgias. You may experience muscle inflammation and an elevated marker of muscle injury called creatine kinase.

How do statins work?

Statins are commonly prescribed drugs used to treat high cholesterol. They work by blocking the enzyme that makes cholesterol in the body. Often people treated with statins respond well, and their cholesterol levels lower. In other instances, a person can develop statin intolerance, which can be dangerous.

Can you change which statin you are taking?

Your doctor may change which statin you’re taking. There are several statin options, and you may have a better reaction with a different type. Your doctor may also prescribe non-statin cholesterol-lowering drugs.

Can statins cause problems?

Many statin problems are related to dosage. Your doctor may reduce the amount you are taking to see if it reduces your symptoms. They may prescribe a lower dosage or even decrease the number of days per week you take your medicine.

Can statins cause side effects?

You should talk to your doctor if you think you’re experiencing statin side effects. A different medication you’re taking could cause side effects could cause or indicate an underlying condition. Resolving your symptoms may be as simple as switching your medicines.

Is statin intolerance serious?

Statin intolerance is very serious, so always talk to your doctor before you stop taking your medicine or taking new medicines.

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Drug Allergy vs. Intolerance

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An allergic reaction occurs when the immune system overreacts to a harmless substance, such as a drug, which triggers an allergic response. Intolerances to drugs may produce similar symptoms, but do not involve the immune system. For example: A patient may indicate that he is “allergic to penicillin” because he experi…
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Adverse Effect Example

  • Here’s an example of an adverse effect from a properly prescribed and properly administered drug and how to code: Initial encounter for opioid-induced constipation due to hydrocodone the patient takes for chronic pain. Chronic pain caused by lumbosacral spinal stenosis and intervertebral disc disorders in the thoracic region with radiculopathy, which were diagnosed four years ago. K59.0…
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Allergic Reaction Example

  • Here’s an example of an allergic reaction to medication: Initial encounter for a patient who went into anaphylactic shock after taking properly prescribed and properly administered penicillin for cellulitis of the buttock. T88.6XXA Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, initial encounter T36...
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Documentation Must Be Specific

  • If you’re in a position to educate your service providers or clinical staff, ask them to be specific about the drug reaction the patient experienced, and to document which drug caused the reaction. This will help differentiate between a patient with a true drug allergy and a patient with a drug intolerance. This documentation may also help support a higher level of medical decision-makin…
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