Toxic effect of chloroform, undetermined, initial encounter

This code signifies an adverse health effect resulting from exposure to chloroform, where the intent of the exposure (e.g., accidental, intentional self-harm, assault) cannot be determined from the available documentation. The "initial encounter" designation indicates that the patient is receiving active treatment for the toxic effect.

Apply this code when a patient presents with symptoms or conditions directly attributable to chloroform exposure, and the medical record does not specify whether the exposure was accidental, intentional, or due to assault. This is appropriate for the first visit where the patient is being evaluated and treated for the acute effects of the poisoning.

• Always review the medical record for any indication of intent; if intent is documented, a more specific T53.1X1-T53.1X3- code should be used.
• Ensure the "A" for initial encounter is appropriate for the patient's current phase of care. Subsequent encounters would use "D" or "S."
• Code any associated signs, symptoms, or specific organ damage resulting from the chloroform toxicity in addition to this code.