ICD-10 and the Value of Drug Underdosing Documentation

The implementation of ICD-10 allows us to capture “drug underdosing” for the first time, which can provide insights on hospital readmissions. This new data could prove invaluable as reimbursement models shift toward accountable care.

What is underdosing?

Underdosing occurs when a patient takes less of a medication than is prescribed by the provider or the manufacturer’s instructions. Underdosing often leads to a relapse or even an exacerbation of the initial diagnosis.

Two examples of underdosing:

  1. A patient is prescribed the antibiotic tetracycline to treat a UTI (urinary tract infection). The patient did not take the medication as prescribed, which resulted in a kidney infection.
  2. A patient is prescribed prednisone for rheumatoid arthritis and has been taking it long-term. The patient abruptly stopped taking the medication, which resulted in secondary adrenal insufficiency. The patient is aware of the risk of not being weaned from steroidal drugs but could not afford to pay for the medication.

Why is this important?

The ability to report underdosing is important as a decline in a patient’s condition can raise quality of care issues, which can additionally have an impact on reimbursement.

Through the classification system, we can both identify what drug is underdosed and if it was intentional (e.g. due to financial reasons) or unintentional (e.g. due to dementia, etc.). By capturing this information, we can analyze and potentially predict readmissions for certain medical conditions and put measures in place through work intervention, patient education, or provide financial assistance, which will help reduce drug underdosing and ultimately improve patient health outcomes and reduce health care costs.

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