Are you a medical coding student currently studying external cause codes? Here is a great way to supplement your studies and familiarize yourself with the different categories listed in Chapter 20 of your ICD-10-CM.
Happy New Year! New Year's Eve is a time of celebration, setting goals, and resolutions. However, it is also one of the busiest times for hospitals and urgent care centers. This is probably one of the top holidays with the wildest reported external cause codes.
As a medical coding student, you will learn all about these codes in the Index to External Causes of Injuries and Chapter 20: External Causes of Morbidity (V00-Y99) in your ICD-10-CM manual. These codes give context to an accident or injury. It is the who, what, where, and how of medical codes.
As a student, I try different ways to supplement my studies. Coding crazy misadventures that occur during the holiday season has helped me learn more about these types of codes and it will help you too. You are going to learn the crazy but true mishaps that happened throughout the years on New Year's Eve and ask yourself, "Is there a code for that?"
This activity will familiarize you with external cause codes.
As you flip through the ICD-10 manual you will notice there are two types of indexes. The largest index is the Alphabetic Index to Diseases and Injuries and the second is the Index to External Causes of Injuries. Some of the categories of this index include main terms for an accident, activity, burn, collision, struck, and even war.
This is where you will find the answers to who was injured, what type of accident or injury, where it took place, and how it occurred. It is important to remember that these codes are secondary and should never be used as primary or first listed diagnosis. The purpose of these codes is to provide additional information.
Now, I am not a professional coder yet. I am a student and these activities are not about trying to determine the correct code. My goal with these learning activities is to familiarize myself with the indexes, tabular lists, and chapter guidelines. Familiarizing yourself with these main terms and codes will help you better understand the ICD-10 manual and be more knowledgeable about how to use it.
Let's code!
Falling off a moving taxi
Immediately, I thought of only New York. Except, this occurred in Madrid, Spain. Instead of jumping in a taxi to get a ride, a man jumped on top of a taxi. Unfortunately, he fell off and hit his head on the curb suffering a concussion after the driver turned a corner.
To search for this code I flipped the pages to Index to External Causes of Injuries and looked up the following main terms:
Main Term: Fall
Sub Term: vehicle (in motion) NEC (see also Accident, transport) V89.9
Tabular List: V89.9 Person injured in unspecified vehicle accident
In this section, there is an instructional note that states: The appropriate 7th character is to be added to each code from category V89.
A = initial encounter.
D = subsequent encounter.
S = sequela
Because this is an initial encounter, the code is V89.9XXA
Main Term: Accident
The previous sub-term had a see also notation so let's check Accident, transport.
Sub-term: Transport
This section contains a lot of sub-terms! The sub-terms are categorized by the type of transport and further specified who was injured such as driver, occupant, passenger, pedestrian, etc. Doing this coding exercise I learned how to differentiate between the many sub-terms located in the Accident section of this Index.
Can you locate the appropriate code? If so, comment below.
Celebratory Gun Fire
On New Year's Eve in Lake Mary Florida, minutes before midnight a woman was struck in the face by a metal cylindrical object. At the ER she discovered that a bullet was lodged into her jaw. Upon investigation, police learned that the woman was in a neighbor's backyard celebrating the holiday when she felt a sharp pain in her face followed by blood. So, how did she get shot? Police determined that it was celebratory gunfire. Do you remember the saying what goes up, must come down? Well, if shots are fired into the air they can travel up to 1.5 miles. So, how do we code struck by a bullet? There are several main terms we can check. Listed below are ones about the injury found in the Index to External Causes of Injury and the corresponding code located in the Tabular section.
Main Term: Gunshot wound
Gunshot wound, W34.00
Tabular List: W34.00 Accidental discharge from unspecified firearms or gun
This code has a 7th character notation which indicates that the code should contain 7 characters. The correct code would be W34.00XA
Main Term: Struck, bullet (see also, Discharge, firearm by type)
Sub-term: bullet (see also Discharge, firearm by type)
Main Term: Discharge (accidental)
Sub-term: firearm (accidental)
The type of firearms listed below this subterm includes handgun, hunting rifle, shotgun, machine gun, pistol, and a few other types. Further specifications include assault, homicide attempt, and legal intervention.
Doing this coding exercise I learned that under the main term Discharge, it is categorized by firearm type and the tabular list contains multiple notations and symbols that need to be read before you can properly code.
Can you code this incident? If so, comment below.
Fireworks Decapitation
"Man decapitated in New Year's fireworks accident in France," is a headline that would grab anyone's attention. I was so shocked I had to read it twice. Every year there are thousands of reported incidents of fireworks injuries. Some have been fatal. In France on New Year's a man and his friend lit fireworks. After they failed to explode the man and his friend approached the fireworks to inspect them. At that moment the fireworks detonated severely injuring one and decapitating the other.
Main Term: Decapitation (accidental circumstances) NEC X58
Sub-terms: homicide X99.9 or legal execution-see Legal, intervention
Tabular list: X58 Exposure to other specified factors.
This particular code seemed very vague so I went back to the index and looked up Detonation. There was no category for this term. Next, I tried explosion. Bingo!
Main Term: Explosion
Sub-term: Fireworks W39
Tabular List: W39 Discharge of firework
Instructional notes state to assign the appropriate 7th character. The 7 alphanumerical characters will be W39.XXXA.
What other external cause codes can we use to code this incident? Comment below!
First Glue & Then Spray
Okay, let's talk about this series of unfortunate events that happened to a young woman on New Year's eve. Getting ready for a night of New Year's eve celebrations should not land you in the ER. However, that is exactly what happened to this woman in New York. As she was getting ready she intended to put her antibiotic drops in her eyes. Instead, she accidentally dripped super glue into her eyes sealing them shut. Immediately she rushed to the ER. On her way there she reached into her purse and used her breath spray. Well, she thought it was breath spray. She used her pepper spray instead and it caused a burning pain in her chest. So, one hour before the ball dropped this woman spent the remaining year in the ER with a burning sensation in her chest and eyes glued shut.
Main Term: Injury
Sub-terms: self-inflicted X83.8 or stated as accidental X58 or specified cause NEC X58.
Code X58 is very vague and I believe I can code a higher specificity. However, searching for the main terms for this incident was hard. Eventually, I flipped to Table of Drugs and Chemicals and searched for glue. Under Substance I did find Glue NEC.
Substance: Glue NEC
Sub-term: Poisoning, Accidental (unintentional), T52.8X1
Tabular List: T52.8X1, Toxic effects of other organic solvents, accidental (unintentional). Per the 7th character symbol, the correct code is T52.8X1A.
This code is located in Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes. However, we can include external cause codes such as the place of occurrence.
Main Term: Place
Sub-term: residence (non-institutional) (private), apartment, bathroom Y92.031
Tabular List: Y92.031 Bathroom in apartment as the place occurrence of the external cause.
Main Term: Ingestion
To code using pepper-spray, I looked up ingestion in the index of External Causes to Injuries.
Sub-term: substance NEC - see Table of Drugs and Chemicals. I could not find pepper spray as a substance in this section. So, I googled it. I learned that pepper spray is also known as capsicum spray and there's a code for that!
Substance: Capsicum
Sub-term: Poisoning, Accidental T49.4X1
Tabular List: A 7th character is required for this code. The appropriate code with the 7th character is T49.4X1A Poisoning by keratolytics, keratoplastics, and other hair treatment drugs and preparations, accidental (unintentional).
What are the other external cause codes that can be use to code this incident? Comment below!
Shark Attack
Everyone has at least one wild story of an eventful New Year's eve night or knows of someone with an unforgettable tale. This is one. Did you hear about the woman who survived a shark attack on New Year's eve in Hawaii? While enjoying her last surf of the year a woman felt a very large presence behind her. The shark attacked and latched onto her leg, but she did not let fear override her. She fought back. Using her surfboard as a weapon she dislodged the shark from her leg and swam back to shore. This is truly an amazing tale of survival.
Main Term: Bite, bitten by
Sub-term: shark W56.41
Tabular List: W56.41XA
Pay attention to the Excludes 1 note that states, contact with venomous marine animal (T63.-)
Main Term: Contact
Sub-term: shark W56.41
Further specificity allows you to choose from 2 options: bite W56.41 or strike W56.12
A code for surfing can be documented to specify what the victim was doing when the attack occurred.
Main Term: Activity
Sub-term: surfing Y93.18
Tabular List: Y93.18 Activity, surfing, windsurfing and boogie boarding
Are there any other external cause codes that can be used to code this incident? Let me know with a comment below.
Now, if you have reviewed the ICD-10 Index to External Causes of Injuries and the tabular list Chapter 20: External Causes of Morbidity, you would have noticed there are a lot of terms! Here are a few quick notes to help you navigate through the many main and sub-terms listed in the index.
Remember the purpose of this index is to code how an injury or accident occurred, who it happened to, what they were doing, and where it happened. These quick notes will help familiarize you with some of the terms used to describe the who, what, where, and how.
Quick Notes:
- driver
- passenger
- car occupant
- bus occupant
- dirt bike rider
- animal-rider
- pickup truck occupant
- occupant (of)
- motorcyclist
- pedestrian
- parachutist
Main term: Accident
- alpine skiing
- basketball
- bike riding
- climbing
- crocheting
- dancing
- game playing
- lacrosse
- milking an animal
- riding
- surfing
- wrestling
Main term: Activity
- abandoned house
- bridge
- cafe
- farm
- football field
- garage
- hockey rink
- library
- office building
- home
- vehicle (transport)
- yard
Main term: Place
- arson
- bodily force
- bomb
- brawl
- burning
- crashing of
- drowning
- hot object
- knife
- firearm
- poisoning
- struck by
After reviewing this index, comment below some of the craziest terms that caught your attention.
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