Ecstasy Ingestion – ER Visit
Medical Specialty: Emergency Room Reports
Description: Patient went out partying last night and drank two mixed drinks last night and then over the course of the evening after midnight, the patient ended up taking a total of six Ecstasy tablets.
CHIEF COMPLAINT: “I took Ecstasy.”
HISTORY OF PRESENT ILLNESS: This is a 17-year-old female who went out partying last night and drank two mixed drinks last night and then over the course of the evening after midnight, the patient ended up taking a total of six Ecstasy tablets. The patient upon returning to home was energetic and agitated and shaking and had one episode of nonbloody, nonbilious emesis. Mother called the EMS service when the patient vomited. On arrival here, the patient states that she no longer has any nausea and that she feels just fine. The patient states she feels wired but has no other problems or complaints. The patient denies any pain. The patient does not have any auditory of visual hallucinations. The patient denies any depression or suicidal ideation. The patient states that the alcohol and the Ecstasy was done purely as a recreational thing and not as an attempt to harm herself. The patient denies any homicidal ideation. The patient denies any recent illness or recent injuries. The mother states that the daughter appears to be back to her usual self now.
REVIEW OF SYSTEMS: CONSTITUTIONAL: No recent illness. No fever or chills. HEENT: No headache. No neck pain. No vision change or hearing change. No eye or ear pain. No rhinorrhea. No sore throat. CARDIOVASCULAR: No chest pain. No palpitations or racing heart. RESPIRATIONS: No shortness of breath. No cough. GASTROINTESTINAL: One episode of nonbloody, nonbilious emesis this morning without any nausea since then. The patient denies any abdominal pain. No change in bowel movements. GENITOURINARY: No dysuria. MUSCULOSKELETAL: No back pain. No muscle or joint aches. SKIN: No rashes or lesions. NEUROLOGIC: No dizziness, syncope, or near syncope. PSYCHIATRIC: The patient denies any depression, suicidal ideation, homicidal ideation, auditory hallucinations or visual hallucinations. ENDOCRINE: No heat or cold intolerance.
PAST MEDICAL HISTORY: None.
PAST SURGICAL HISTORY: Appendectomy when she was 9 years old.
CURRENT MEDICATIONS: Birth control pills.
ALLERGIES: NO KNOWN DRUG ALLERGIES.
SOCIAL HISTORY: The patient denies smoking cigarettes. The patient does drink alcohol and also uses illicit drugs.
PHYSICAL EXAMINATION: VITAL SIGNS: Temperature is 98.8 oral, blood pressure 140/86, pulse is 79, respirations 16, oxygen saturation 100% on room air and is interpreted as normal. CONSTITUTIONAL: The patient is well nourished, and well developed, appears to be healthy. The patient is calm and comfortable, in no acute distress and looks well. The patient is pleasant and cooperative. HEENT: Head is atraumatic, normocephalic, and nontender. Eyes are normal with clear cornea and conjunctiva bilaterally. The patient does have dilated pupils of approximately 8 mm each and are equally round and reactive to light bilaterally. No evidence of light sensitivity or photophobia. Extraocular motions are intact bilaterally. Nose is normal without rhinorrhea or audible congestion. Ears are normal without any sign of infection. Mouth and oropharynx are normal without any signs of infection. Mucous membranes are moist. NECK: Supple and nontender. Full range of motion. There is no JVD. CARDIOVASCULAR: Heart is regular rate and rhythm without murmur, rub or gallop. Peripheral pulses are +3 and bounding. RESPIRATIONS: Clear to auscultation bilaterally. No shortness of breath. No wheezes, rales or rhonchi. Good air movement bilaterally. GASTROINTESTINAL: Abdomen is soft, nontender, normal and benign. MUSCULOSKELETAL: No abnormalities noted in back, arms, or legs. The patient is normal use of her extremities. SKIN: No rashes or lesions. NEUROLOGIC: Cranial nerves II through XII are intact. Motor and sensory are intact in all extremities. The patient has normal speech and normal ambulation. PSYCHIATRIC: The patient is alert and oriented x4. The patient does not have any smell of alcohol and does not exhibit any clinical intoxication. The patient is quite pleasant, fully cooperative. HEMATOLOGIC/LYMPHATIC: NO lymphadenitis is noted. No bruising is noted.
DIAGNOSES:
1. ECSTASY INGESTION.
- ALCOHOL INGESTION.
3. VOMITING SECONDARY TO STIMULANT ABUSE.CONDITION UPON DISPOSITION: Stable disposition to home with her mother.PLAN: I will have the patient followup with her physician at the ABC Clinic in two days for reevaluation. The patient was advised to stop drinking alcohol, and taking Ecstasy as this is not only in the interest of her health, but was also illegal. The patient is asked to return to the emergency room should she have any worsening of her condition, develop any other problems or symptoms of concern.
Start with the Reason for the Visit
Always begin by asking why the patient is here today. In this case, the patient took six Ecstasy (MDMA) tablets, developed vomiting and agitation, and came to the ER. Right away, this tells you that you are coding a drug ingestion or overdose scenario. In ICD-10-CM, that usually means the poisoning code comes first.
ICD-10-CM Coding (Diagnosis Coding)
Primary Diagnosis: Poisoning Code
Ecstasy (MDMA) is a stimulant. To find the code, start in the Index under Poisoning, then follow Drug, Stimulant, and Ecstasy.
Code: T43.641A Poisoning by ecstasy, accidental (unintentional), initial encounter
Why This Code?
The patient took more than she intended, so this is poisoning, not just use. In addition, the documentation states she was not suicidal and that this was recreational use. As a result, the record supports accidental (unintentional) intent.
CPC Tip
When you see an overdose, think poisoning first. In other words, assign the T code rather than coding only abuse or use.
Additional Symptom Code
R11.10 Vomiting, unspecified
Why?
The guidelines instruct you to code all manifestations of a poisoning. In this case, the patient had documented vomiting. Even though it resolved, it was clinically relevant, so you report it.
Additional Condition: Stimulant Abuse
F15.10 Other stimulant abuse, uncomplicated
Why Include This?
The provider specifically documents “vomiting secondary to stimulant abuse.” Under the guidelines, when poisoning and abuse are both documented, you code both. The poisoning code goes first, and the abuse code is additional.
What About Alcohol?
You might be tempted to code alcohol, but don’t.
Why Not Code Alcohol?
The patient had only two drinks. Furthermore, the provider states there was no intoxication and gives no diagnosis related to alcohol. Since no condition is tied to alcohol, there is nothing to code.
CPC Exam Tip
Do not code everything mentioned. Instead, code only what is clinically relevant and documented as a condition.
Coding Clarified Final ICD-10-CM Codes
- T43.641A (primary)
- R11.10
- F15.10
CPT Coding (E/M for ER Visit)
Next, we code the Emergency Department visit. The key rule is that ED codes 99281 through 99285 are based on Medical Decision Making (MDM).
Evaluate the MDM
Problems
Drug ingestion is potentially serious. However, the patient was stable and improved.
Data
The record documents no labs, no imaging, and no toxicology screens.
Risk
Drug ingestion carries some risk. Even so, the patient required no treatment and no IV medications, and the provider discharged her in stable condition.
Final CPT Code
99283 Emergency department visit, low level of medical decision making
Why Not 99284?
The chart shows no diagnostics, no significant intervention, no prescription drug management, and no admission or observation. The current CPT E/M framework bases ED code selection on MDM, where 99283 is low MDM and 99284 is moderate MDM. Therefore, the conservative choice for this chart is 99283.
CPC Exam Tip
If the patient is stable, the workup is minimal, and the provider discharges the patient home, think 99283.
HCPCS Coding
The answer here is none. HCPCS Level II covers drugs, supplies, ambulance services, and DME. However, none of these were given, documented, or billed separately in this visit.
Final Code Summary
CPT
- 99283
ICD-10-CM
- T43.641A
- R11.10
- F15.10
T43.641A Poisoning by ecstasy, accidental (unintentional), initial encounter. CMS and NCHS coding guidance says to code an overdose as a poisoning and to assign the poisoning code first. In addition, the CMS drug and chemical addenda list Ecstasy/MDMA under T43.64. Because the note explicitly says this was recreational and not self-harm, the best-supported intent is accidental (unintentional).
R11.10 Vomiting, unspecified. The FY 2026 ICD-10-CM guidelines instruct you to use additional codes for all manifestations of poisonings. Also, the chart specifically diagnoses “vomiting secondary to stimulant abuse.”
F15.10 Other stimulant abuse, uncomplicated. The provider documents “vomiting secondary to stimulant abuse,” so an additional abuse code is supportable. Moreover, the FY 2026 guidelines state that when poisoning occurs with abuse or dependence, you assign the abuse or dependence as an additional code.
HCPCS
None. This note alone supports no HCPCS code, because the ED record documents no separate drug administration, infusion, supply, observation service, or other reportable item.
CPC Exam Strategy Takeaways
Poisoning vs Abuse
An overdose is a poisoning, so the T code comes first. Additionally, you can add abuse when the provider documents it.
Do not separately code alcohol poisoning or alcohol intoxication from this note. The record says she drank two mixed drinks and had no clinical intoxication on exam. Furthermore, there is no diagnosed alcohol use disorder or alcohol-induced condition. The ecstasy poisoning is the main reportable substance event here.
A payer or auditor could argue for a different ED E/M level if there were additional undocumented data reviewed, a toxicology consultation, continuous monitoring, or prolonged observation. Based only on what is written here, however, 99283 is the safest choice.
Code Symptoms with Poisoning
Always capture the manifestations of a poisoning, such as vomiting.
Don’t Overcode
Just because the record mentions alcohol does not mean you code it. In short, code only what the provider diagnoses and what is clinically relevant.
E/M Level Logic
For example, no labs plus a stable discharge usually points to 99283.
Related Resources
Alcohol Use, Abuse, and Dependence Coding