May 04, 2012 | | Comments 2
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Coding for the zombie invasion

Braaaaains!

Braaaaains!

Don’t look now, but the Centers for Disease Control and Prevention was right about the zombie apocalypse. It’s here! Run for your lives!

Okay, we’re not about to be overrun by brain-munching undead. But as it turns out, several diseases could turn you into a zombie, if you got them all at once. Really, what are the chances of that happening? Let’s look at the diseases and see how we would code them in ICD-10-CM. Then we’ll be prepared when the zombie do eventually attack.

First up is sleeping sickness. Odds are you won’t see these cases very often because it is more prevalent in Africa. Sleeping sickness is caused by the parasite Trypanosoma brucei and transmitted by the tsetse fly.

When we look up sleeping sickness in the ICD-10-CM alphabetic index, we’re directed to sickness, sleeping. Really? They couldn’t just include it under sleeping sickness? Oh well, it’s only one page away in the 2012 index. It turns out we have three choices for sleeping sickness:

  • B56.0, Gambiense trypanosomiasis
    • Infection due to Trypanosoma brucei gambiense
    • West African sleeping sickness
  • B56.1, Rhodesiense trypanosomiasis
    • East African sleeping sickness
    • Infection due to Trypanosoma brucei rhodesiense
  • B56.9, African trypanosomiasis, unspecified
    • Sleeping sickness NOS

So we need to know where our patient was when bitten by the tsetse fly. Avoid the unspecified unless you have no choice.

Although no current medically recognized disease causes cannibalism, rabies could cause a zombie wannabe to seek out brains. Here again we need to know where our patient was when infected—an urban environment or a wooded one.

  • A82.0, sylvatic rabies
  • A82.1, urban rabies
  • A82.9, rabies, unspecified

We also have some other choices under rabies when we look in the alphabetic index. The patient could have been exposed to rabies or come into contact with it, but not contracted it. In that case, we would report code Z20.3. Maybe our patient is trying to avoid becoming a zombie and received a rabies vaccine. That could lead to an inoculation reaction. The ICD-10-CM index directs us to complications, vaccination to find the code for the adverse reaction.

What about the rotting flesh look most zombies fashion? That can be explained by necrosis. Technically, it’s not a disease but a condition with a lot of different possible causes—cancer, poison, injury, and infection among them.

But just to be sure we’re prepared; we’ll consider this as a cause of zombie-itis. We need a lot of information in order to code necrosis. The codes for necrosis are spread throughout the ICD-10-CM manual, depending on where the condition occurs.

For example, if our zombie showed necrosis of the jaw, which would explain the gaping mouth, we would report M27.2. If the necrosis occurred in the cornea (hence the poor eyesight), we would code H18.40 (unspecified corneal degeneration).  Even though the code doesn’t require laterality, it’s a good idea for the physician to document it. After all, you never know when your zombie will return.

The physician also needs to document all of the sites where necrosis occurs so we can report all of them, internal and external.

What is causing our zombie’s shuffling gait? Could it be Hansen’s disease, aka leprosy? And yes, if you look up Hansen’s disease, the index directs you to leprosy, but if you look up leprosy, you’re in the right place. Assuming of course, the physician documents the type of leprosy our zombie contracted.

  • A30.0, indeterminate leprosy
  • A30.1, tuberculoid leprosy
  • A30.2, borderline tuberculoid leprosy
  • A30.3, borderline leprosy
  • A30.4, borderline lepromatous leprosy
  • A30.5, lepromatous leprosy
  • A30.8, other forms of leprosy
  • A30.9, leprosy, unspecified

Remember that other forms of leprosy and unspecified leprosy are two different things. If we code A30.8, we know what type of leprosy our zombie has, but ICD-10-CM doesn’t include a code for it. We would only report A30.9 if the physician didn’t document the type of leprosy and our query was unsuccessful.

Let’s move on to our final sign of zombie-itis, the noises emulating from our zombie, specifically those moans and grunts. Turns out our zombie could be suffering from dysarthria, which is a disorder affecting the motor controls of human speech.

Before we can code, we need to know what caused it. A complete medical history is a must. So is complete documentation. It doesn’t do us any good if the physician knows this information but doesn’t write it down.

Did our zombie suffer a nontraumatic intracerebral hemorrhage? If so, we would code I69.122. Maybe the dysarthria developed after a nontraumatic subarachnoid hemorrhage (I69.022), some other nontraumatic intracranial hemorrhage (I69.222), or possibly a cerebral infarction (I69.322).

So basically, as long as none of your patients come in with sleeping sickness, rabies, necrosis , leprosy, and dysarthria, you should be safe from zombies. But it wouldn’t hurt to put together one of the CDC’s zombie preparedness kits.

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Michelle A. Leppert About the Author: Michelle A. Leppert, CPC, is a senior managing editor for JustCoding.com. JustCoding provides coders, coding supervisors, and health information management (HIM) directors with educational resources to test their coding knowledge, employ correct coding guidelines, and stay abreast of CMS transmittals.

In addition, she writes and edits the HCPro publication, Briefings on Coding Compliance Strategies. Email her at mleppert@hcpro.com.

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  1. Love it! I’m a huge fan of zombies in medical billing: http://www.kareo.com/blog/2011/05/medical-billing-software-update-how-to-handle-medical-billing-after-a-zombie-apocalypse/

    It’s best to be prepared. Well done.

  2. Who could not love this? The ICD-10 training does an excellent job of presenting the logical thinking in recording the diagnoses of a patient’s ailments. The movies make us think that being a zombie is one disease rather than a complex of conditions.

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