The Alphabetical Index should be consulted to determine which symptoms and signs are to be allocated here and which to other chapters. Practically all categories in the chapter could be designated 'not otherwise specified', 'unknown etiology' or 'transient'. In general, categories in this chapter include the less well-defined conditions and symptoms that, without the necessary study of the case to establish a final diagnosis, point perhaps equally to two or more diseases or to two or more systems of the body. Signs and symptoms that point rather definitely to a given diagnosis have been assigned to a category in other chapters of the classification.This chapter includes symptoms, signs, abnormal results of clinical or other investigative procedures, and ill-defined conditions regarding which no diagnosis classifiable elsewhere is recorded.According to ICD-10-CM guideline I.C.19.e the codes for poisoning include the intent and the substance taken no additional external cause code is required. There is no mention of drug abuse or drug use outside of the suicide attempt. In the Tabular List, Unconsciousness NOS is an inclusion term under R40.20. Look in the ICD-10-CM Alphabetic Index for Unconscious(ness) which states to see Coma which directs you to R40.20. In the Tabular List, 7th character A is selected for the initial encounter. Look in the ICD-10-CM Table of Drugs and Chemicals for LSD, and select the code from the Poisoning, Intentional Self-harm column which directs the you to T40.8X2. Any diagnosis of drug abuse or dependence is assigned as an additional code. ICD-10-CM guideline I.C.19.e.5.b states that a poisoning is reported by first assigning the poisoning code (categories T36-T50), followed by a code for each manifestation. T40.8X2A, R40.20 Rationale: According to ICD-10-CM guideline I.C.19.e.5.b.ii, an overdose of a drug intentionally taken is reported as a poisoning. Verify the code selection in the Tabular List. Look in the Alphabetic Index for Vomiting directing you to code R11.10. The last code is for the vomiting that developed during treatment. When the site of the primary cancer is unknown, look for Neoplasm, neoplastic and select from the Malignant Primary column which directs the coder to C80.1. Look for Neoplasm, neoplastic/bone (periosteum) and select the code from the Malignant Secondary column which directs you to C79.51. Next, look in the Alphabetic Index for Metastasis, metastatic/cancer/from specified site and you are directed to see Neoplasm, malignant, by site. In the ICD-10-CM Alphabetic Index look for Encounter (with health service) (for)/radiation therapy (antineoplastic), guiding you to code Z51.0. ICD-10-CM guideline I.C.2.b states the secondary cancer is listed first when the treatment is directed toward the secondary site only. ICD-10-CM guideline I.C.2.e.3 states if a patient admission is for the purpose of radiotherapy, immunotherapy, or chemotherapy and develops complications, assign code Z51.0 Encounter for antineoplastic radiation therapy, or Z51.11 Encounter for antineoplastic chemotherapy, or Z51.12 Encounter for antineoplastic immunotherapyas the first-listed or principal diagnosis, followed by any codes for the complications. Z51.0, C79.51, C80.1, R11.10 Rationale: The reason for the encounter is for radiation therapy.
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