Medical Specialty: General Medicine
Description: Patient is a three years old male who about 45 minutes prior admission to the emergency room ingested about two to three tablets of Celesta 40 mg per tablets.
HISTORY OF PRESENT ILLNESS: Patient is a three years old male who about 45 minutes prior admission to the emergency room ingested about two to three tablets of Celesta 40 mg per tablets. Mom called to the poison control center and the recommendation was to take the patient to the emergency room and be evaluated. The patient was alert and did not vomit during the transport to the emergency room. Mom left the patient and his little one-year-old brother in the room by themselves and she went outside of the house for a couple of minutes, and when came back, she saw the patient having the Celesta foils in his hands and half of tablet was moist and on the floor. The patient said that the pills “didn’t taste good,” so it is presumed that the patient actually ingested at least two-and-a-half tablets of Celesta, 40 mg per tablet.
PAST MEDICAL HISTORY: Baby was born premature and he required hospitalization, but was not on mechanical ventilation. He doesn’t have any hospitalizations after the new born. No surgeries.
IMMUNIZATIONS: Up-to-date.
ALLERGIES: NOT KNOWN DRUG ALLERGIES.
PHYSICAL EXAMINATION
VITAL SIGNS: Temperature 36.2 Celsius, pulse 112, respirations 24, blood pressure 104/67, weight 15 kilograms.
GENERAL: Alert, in no acute distress.
SKIN: No rashes.
HEENT: Head: Normocephalic, atraumatic. Eyes: EOMI, PERRL. Nasal mucosa clear. Throat and tonsils, normal. No erythema, no exudates.
NECK: Supple, no lymphadenopathy, no masses.
LUNGS: Clear to auscultation bilateral.
HEART: Regular rhythm and rate without murmur. Normal S1, S2.
ABDOMEN: Soft, nondistended, nontender, present bowel sounds, no hepatosplenomegaly, no masses.
EXTREMITIES: Warm. Capillary refill brisk. Deep tendon reflexes present bilaterally.
NEUROLOGICAL: Alert. Cranial nerves II through XII intact. No focal exam. Normal gait.
RADIOGRAPHIC DATA: Patient has had an EKG done at the admission and it was within normal limits for the age.
EMERGENCY ROOM COURSE: Patient was under observation for 6 hours in the emergency room. He had two more EKGs during observation in the emergency room and they were all normal. His vital signs were monitored every hour and were within normal limits. There was no vomiting, no diarrhea during observation. Patient did not receive any medication or has had any other lab work besides the EKG.
ASSESSMENT AND PLAN: Three years old male with accidental ingestion of Celesta. Discharged home with parents, with a follow-up in the morning with his primary care physician
Scenario Summary (for Coding Context)
Patient: 3-year-old male
Setting: Emergency Department
Issue: Accidental ingestion of 2–3 tablets of Celesta 40 mg
Timing: ~45 minutes prior to arrival
Course: Asymptomatic, normal exams, poison control consulted, 6-hour ER observation, serial EKGs, discharged home
ICD-10-CM Diagnosis Codes
Primary Diagnosis
T50.901A – Poisoning by unspecified drugs, medicaments and biological substances, accidental (unintentional), initial encounter
Rationale:
The documentation identifies accidental ingestion of a medication.
Celesta is not clearly categorized in ICD-10-CM as a specific drug class (e.g., opioid, benzodiazepine).
When the drug class is not explicitly defined, T50.901A is appropriate.
7th character “A” is required because this is the initial encounter for poisoning.
External Cause Code (Secondary)
X40 – Accidental poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics
Optional / payer-dependent
Rationale:
Used to further explain how the poisoning occurred.
External cause codes are not mandatory for reimbursement but are often required for:
Pediatric cases
Quality reporting
Public health data
Place of Occurrence (Optional)
Y92.009 – Place of occurrence, unspecified home
Rationale:
The ingestion occurred at home.
This code adds contextual detail but does not affect payment.
Activity Code (Optional)
Y93.9 – Activity, unspecified
Rationale:
The child was not engaged in a defined activity (e.g., sports).
Often omitted unless required by payer or state reporting.
Codes NOT Assigned (With Rationale)
No symptom codes (e.g., nausea, vomiting) → Patient remained asymptomatic
No Z91.89 (noncompliance) → This was accidental, not neglect or misuse
No adverse effect code → This is poisoning, not a therapeutic adverse reaction
CPT / HCPCS Procedure Codes
Emergency Department E/M
99284 – Emergency department visit, moderate severity
Rationale:
Poisoning ingestion in a pediatric patient
Required poison control consultation
6-hour monitored observation
Multiple EKGs
Meets moderate MDM despite stable presentation
99283 would generally be too low given the risk profile of pediatric ingestion.
Electrocardiograms
93000 – Electrocardiogram, routine ECG with interpretation and report
Units: 3
Rationale:
One EKG at admission
Two additional EKGs during observation
Each EKG was performed, interpreted, and documented
If provider interpretation was not documented, payer may require:
93005 (tracing only), or
93010 (interpretation only)
Observation Coding
Do NOT bill observation CPT codes (99218–99220)
Rationale:
Observation occurred within the ER
Patient was not formally admitted to observation status
ED observation time is bundled into the ED E/M code
Coding Logic Summary
Category Code Why It Applies
Primary Dx T50.901A Accidental medication ingestion, unspecified drug
External Cause X40 Describes accidental poisoning
Place Y92.009 Occurred at home
E/M 99284 Pediatric poisoning + monitoring
EKG 93000 ×3 Serial EKG monitoring
Final Notes for Coders
Always confirm drug classification before defaulting to T50.901A
Pediatric ingestions almost always justify moderate MDM
ER observation ≠ Observation admission
Serial diagnostics must be documented to bill multiple units