Medical Coding Guide

Description of Sodium iodide I-131 Sodium iodide I-131 (Na131I), is an oral radioactive iodide isotope that is used both therapeutically and diagnostically. The radiopharmaceutical is selectively trapped by non-malignant and, to a lesser degree, malignant thyroid tissue. Sodium iodide I-131 was approved in 1957 for radioactive iodide ablation in the treatment of hyperthyroidism and select cases of thyroid carcinoma. Radioiodide is not taken up by the majority of medullary and anaplastic carcinomas including giant cell and spindle cell carcinoma of the thyroid or amyloid solid carcinomas. When used therapeutically, the…

Description of Sodium Iodide I 123 Sodium iodide is a nutritional supplement for addition to total parenteral nutrition (TPN) solutions. It is primarily indicated to prevent depletion of endogenous iodine stores and related iodine deficiency symptoms. Iodide is the ionized form of iodine, an essential trace element for humans and an integral part of the thyroid hormones, triiodothyronine (T3) and thyroxine (T4). Iodine was first discovered in 1811 and was noted to sublimate into a violet vapor when heated. Because of this, the element is named after the Greek word…

Description of Dronedarone Dronedarone is an antiarrhythmic agent developed to have similar efficacy to amiodarone with an improved safety and tolerability profile. However, dronedarone carries a boxed warning contraindicating its use in patients with NYHA Class IV heart failure, patients with symptomatic heart failure with recent decompensation, and in patients in atrial fibrillation who cannot be cardioverted into normal sinus rhythm; dronedarone use doubles mortality risk and/or serious adverse events in these populations. In an unpublished trial comparing dronedarone to amiodarone, amiodarone had greater control of cardiac rhythm than dronedarone.…

Description of Abciximab Abciximab was the first FDA-approved platelet glycoprotein IIb/IIIa inhibitor. It is the Fab fragment of the chimeric monoclonal antibody 7E3. The substitution of human IgG for the murine IgG molecule produces a Fab fragment that causes fewer allergic and thrombocytopenic complications. Abciximab was FDA-approved in December 1994. In November 1997, the FDA expanded the indications for abciximab to a broader range of patients undergoing PCI, including those with unstable angina not responding to conventional therapy. Mechanism of Action of Abciximab Abciximab is a noncompetitive inhibitor of glycoprotein…

Description of Edrophonium Edrophonium is a rapid-acting, short-duration, parenteral cholinesterase inhibitor. It is the drug of choice for diagnosing myasthenia gravis because of its rapid onset of action and reversibility. Other uses include assessing cholinesterase inhibitor therapy, differentiating cholinergic and myasthenic crises, and reversing the effects of nondepolarizing neuromuscular blockers after surgery. Edrophonium has been used to terminate paroxysmal atrial tachycardia, but alternative therapies have replaced edrophonium for this use. In combination with atropine sulfate, edrophonium is used adjunctively to treat respiratory depression associated with curare overdosage. Edrophonium was approved…

Description of Valacyclovir  Valacyclovir is an antiviral agent with activity against alpha-herpes viruses. It is FDA approved for the treatment of: herpes labialis (cold sores) in patients 12 years and older; chickenpox in pediatric patients aged 2 to less than 18 years; herpes zoster (shingles) in immunocompetent adults; and genital herpes (initial episode, recurrent episodes, suppressive therapy, and reduction of transmission) in immunocompetent adults. Valacyclovir is the L-valyl ester of acyclovir; the result of an effort to develop a prodrug to improve acyclovir oral bioavailability. Improved bioavailability means less frequent…

Description of Fomepizole Fomepizole is a competitive inhibitor of alcohol dehydrogenase. It is FDA-approved for the treatment of ethylene glycol and methanol poisoning. The drug must be diluted and administered by intravenous infusion over 30 minutes; administration as an undiluted intravenous bolus is associated with venous irritation and phlebosclerosis. If given with hemodialysis, which should be considered in addition to fomepizole in patients with renal failure, worsening metabolic acidosis, or a measured ethylene glycol or methanol concentration 50 mg/dL or greater, the dosing frequency must be increased as fomepizole is…

Description of Fosphenytoin  Fosphenytoin is a water-soluble, parenteral prodrug of phenytoin, a hydantoin anticonvulsant Intravenous (IV) fosphenytoin is used for status epilepticus. IV or intramuscular (IM) fosphenytoin may be substituted short-term for oral phenytoin in situations where oral phenytoin is not appropriate or advantageous. Unlike phenytoin, fosphenytoin is soluble in standard intravenous solutions and is rapidly absorbed via the IM route. Fosphenytoin has fewer local adverse reactions and does not contain propylene glycol; thus, IV doses can be given at a faster rate. Since fosphenytoin is converted to phenytoin in…