EmailSerotonin syndrome
Publication Date: June 2016
ICD 10 AM Edition: Ninth edition
Query Number: 3104
How do I code Seratonin syndrome with no indication of what drugs were involved.
Response
The Australian Prescriber Volume 26 No 3 indicates that Serotonin syndrome is a toxic state caused mainly by excess serotonin within the central nervous system. It results in a variety of mental, autonomic and neuromuscular changes, which can range in severity from mild to life-threatening. Most cases are self-limiting. Severe serotonin syndrome is nearly always caused by a drug interaction involving two or more 'serotonergic' drugs, at least one of which is usually a selective serotonin reuptake inhibitor or monoamine oxidase inhibitor. Management involves withdrawal of the offending drugs, aggressive supportive care and occasionally serotonin antagonists such as cyproheptadine. Treatment of the condition for which the serotonergic drugs were prescribed should be reviewed.
VICC advises the following possible coding options based on the information available in your clinical notes:
1. In accordance with ACS 1902 Adverse effects, if the syndrome is caused by an adverse effect of a drug and a symptom(s) is documented, code the symptom(s) followed by the external cause code to indicate the drug or medicinal agent which caused the adverse effect. As the drug(s) is unknown in your case, assign Y57.9 Drug or medicament, unspecified.
If the manifestation of the adverse drug reaction is unspecified, assign code T88.7 Unspecified adverse effect of drug or medicament.
2. In accordance with ACS 1901 Poisoning if the syndrome is caused by improper use of a drug, assign a code from range T36–T50 Poisonings by drugs, medicaments and biological substances to identify the drug. As the drug(s) is unknown in your case, assign T50.9 Other and unspecified drugs, medicaments and biological substances followed by external cause code Y14 Poisoning by and exposure to other and unspecified drugs, medicaments and biological substances, undetermined intent.
VICC advises the following possible coding options based on the information available in your clinical notes:
1. In accordance with ACS 1902 Adverse effects, if the syndrome is caused by an adverse effect of a drug and a symptom(s) is documented, code the symptom(s) followed by the external cause code to indicate the drug or medicinal agent which caused the adverse effect. As the drug(s) is unknown in your case, assign Y57.9 Drug or medicament, unspecified.
If the manifestation of the adverse drug reaction is unspecified, assign code T88.7 Unspecified adverse effect of drug or medicament.
2. In accordance with ACS 1901 Poisoning if the syndrome is caused by improper use of a drug, assign a code from range T36–T50 Poisonings by drugs, medicaments and biological substances to identify the drug. As the drug(s) is unknown in your case, assign T50.9 Other and unspecified drugs, medicaments and biological substances followed by external cause code Y14 Poisoning by and exposure to other and unspecified drugs, medicaments and biological substances, undetermined intent.
