Death smiles at us all. All a man can do is smile back. (Kudos if you know I appropriated that from the movie Gladiator.)
History is full of weird circumstances and odd injuries that lead to death. Let’s look at some of history’s more (in)famous deaths and see how we would code the injuries that caused death in ICD-10-CM.
Going way back to the 600s B.C., Athenian lawmaker Draco was smothered to death when happy citizens of Aegina showered him with gifts of cloaks. His cause of death was likely asphyxiation. You’ll find the codes for asphyxiation in the T71- series, which covers both mechanical suffocation and traumatic suffocation. Note that all of the codes under T71 require a seventh character to denote the encounter.
T71 also includes an Excludes1 note, which means not coded here. You should never report the excluded code with the code above the Excludes1 note. Be sure to check the Excludes1 note before selecting a code from T71.
In Draco’s case, we would look for a code in the T71.1- (asphyxiation due to mechanical threat to breathing) series since the weight of the cloaks smothered him. T71.1 includes codes for suffocation by:
- Smothering under pillow
- Plastic bag
- Bed linens
- Another person’s body
- In furniture
- By hanging
- Other causes
For Draco, it’s other causes since gifts of cloaks aren’t covered. We also need to know if the asphyxiation was accidental, intentional self-harm, assault, or undetermined. I’m going with accidental, because I don’t think the citizens were trying to kill him, so our code is:
- T71.191A, asphyxiation due to mechanical threat to breathing due to other causes, accidental, initial encounter
Sticking with ancient deaths (455 B.C. to be precise), we can review the tragedy of Aeschylus. According to legend, the playwright died after being hit on the head with a tortoise. Apparently a passing eagle mistook Aeschylus’ head for a rock suitable for shattering the shell of the reptile. Instead, the eagle’s falling dinner shattered Aeschylus’ skull.
For a skull fracture, we need to know the exact bone(s) fractured so we can correctly choose from these codes:
- S02.0, fracture of vault of skull
- S02.1, fracture of base of skull
- S02.2, fracture of nasal bones
- S02.3, fracture of orbital floor
- S02.4, fracture of malar, maxillary and zygoma bones
- S02.5, fracture of tooth (traumatic)
- S02.6, fracture of mandible
- S02.8, fractures of other specified skull and facial bones
- S02.9, fracture of unspecified skull and facial bones
Many of these codes also have subcategories to further specify the exact site of the fracture. All of these codes also require a seventh character to denote the encounter. For some of the codes, such as S02.0, you’ll need to add placeholder Xs, so the seventh character actually ends up in the seventh position.
Aeschylus probably also suffered a traumatic brain injury from the falling tortoise. ICD-10-CM category S06 (intracranial injury) includes all kinds of brain injuries, such as:
- Traumatic cerebral edema
- Diffuse traumatic brain injury
- Focal traumatic brain injury
- Epidural hemorrhage
- Traumatic subdural hemorrhage
- Other specified intracranial injuries
- Unspecified intracranial injury
Again, you’ll need to know the exact nature of the injury and the encounter.
Sadly, while ICD-10-CM does include numerous External Causes codes for being struck by a falling object, none of them specify a tortoise dropped by an eagle. Maybe next year.
Our final fatality for the day comes from 162 B.C. when Eleazar Maccabeus was crushed to death at the Battle of Beth Zechariah by a war elephant that he believed to be carrying Seleucid King Antiochus V. Eleazar ran underneath the elephant and thrust a spear into its belly. Unfortunately for Eleazer, he succeeded in killing the elephant and the elephant promptly returned the favor by crushing him.
Eleazer likely suffered severe head injuries, traumatic asphyxia, and chest injuries such as broken ribs and bruised lungs. We’ve already looked at head injuries (falling tortoises and dying elephants create similar results) and we’ve looked at asphyxia. What about the other injuries?
ICD-10-CM does include codes specifically for crushing injuries, such as:
- S38.1, crushing injury of abdomen, lower back, and pelvis
- S28.0, crushed chest
- S07, crushing injury of head
These codes do include notes instructing you to use additional codes for all associated injuries.
For example, if a patient suffers multiple rib fractures (and I’m guessing falling elephants cause multiple rib fractures), we would add one of the following codes to our crushed chest code:
- S22.41, multiple fractures of ribs, right side
- S22.42, multiple fractures of ribs, left side
- S22.43, multiple fractures of ribs, bilateral
- S22.49, multiple fractures of ribs, unspecified side
We will again need a placeholder X and a seventh character for the encounter.
Had Eleazar survived being squashed by an elephant, he could have died from traumatic rhabdomyolysis. In that case, we would report T79.6 (traumatic ischemia of muscle).