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 firstname.lastname@example.org.
Every once in a while, another facility will send us a case to review and help them code. Here at the Fix ‘Em Up Clinic, we are happy to share our knowledge as we prepare for October 1. In that spirit, we present the following case sent to us from Florida.
Tim and a large group of friends were out biking on a Florida highway when they came across the body of a baby alligator. The alligator suffered multiple crushing injuries as a result of being run over by a really big truck.
The alligator may have been squished, but that didn’t stop it from taking out some cyclists from the hereafter. Several of the cyclists, who were cruising at around 30 miles per hour, hit the baby gator’s body and then the pavement.
Tim suffered the most severe injuries, breaking five ribs, several facial bones, and his clavicle. He also suffered a collapsed lung.
Let’s start at the top of Tim and work our way down.
If you are all set for ICD-10, you’re probably fine tuning your coding and documentation, maybe looking at what improvements you can make to your EMR.
If you’re mostly ready, you’re probably scrambling to figure out what absolutely, positively must be done by October 1.
If you aren’t ready at all, you’re in panic mode.
For those of you in the first group, congratulations! You made the most of the multiple delays and you’re ready for any hiccups you encounter after implementation.
Take Shaun, for example. Shaun is the kicker for Anytown’s high school football team. While making a routine tackle in practice, Shaun’s knee connected with another player’s helmet and he had to be helped off the field.
Shaun comes in to see Dr. Landry at the Fix ‘Em Up Clinic. After an MRI, Dr. Landry diagnoses a grade 3 tear of the left anterior cruciate ligament. Dr. Landry recommends surgery to replace the ligament.
When we look up a torn ligament in the ICD-10-CM Alphabetic Index, we’re directed to “see Sprain.” Once you know ligament tears are classified as sprains, you can head right there in the index.
You can look up “cruciate” under sprain, but you will be directed to the knee so we’ll just head right there.
The absolute best ICD-10 education is completely free, assuming you have an Internet connection. It will tell you everything you need to know about coding in ICD-10.
It’s the Official Guidelines for Coding and Reporting (CM and PCS have their own). Yep, I’m talking about the instruction manual.
And okay, the official guidelines won’t tell you everything. But they are a great place to start.
Several years ago, I attended a conference session on tough ICD-9-CM coding challenges. One of the very first things the speaker said was read, learn, and love the guidelines. True in ICD-9-CM, true in ICD-10-CM, and true in ICD-10-PCS.
I can tell when people have read the directions by the questions they ask. Sometimes, the answers are clearly spelled out in the guidelines. Other times, I need to look in Coding Clinic, or reach out to one of our Boot Camp instructors for help.
Armadillos apparently pose more hazards to your health than just passing on leprosy.
A Texas man recently tried to shoot an armadillo three times and ended up being hit by his own bullet. He claims one of the bullets bounced off the armadillo’s shell and hit him in the face. Local law enforcement believe the bullet really ricocheted off a rock.
Regardless, Sam ended up with a fractured jaw. If Sam came into the Fix ‘Em Up Clinic, we would need some additional information to code his broken jaw. Specifically, which part of his jaw is broken?
ICD-10-CM includes nine possible locations on the jaw:
- S02.600-, fracture of unspecified part of body of mandible
- S02.609-, fracture of mandible, unspecified
- S02.61-, fracture of condylar process of mandible
- S02.62-, fracture of subcondylar process of mandible
- S02.63-, fracture of coronoid process of mandible
- S02.64-, fracture of ramus of mandible
- S02.65-, fracture of angle of mandible
- S02.66-, fracture of symphysis of mandible
- S02.67-, fracture of alveolus of mandible
- S02.69-, fracture of mandible of other specified site
Some, though, can do nasty things.
Consider Legionella pneumophila bacteria. These nasty guys are responsible for at least seven deaths in New York City Legionnaires’ disease outbreak. At least 64 people have been hospitalized.
Legionnaires’ disease falls under category A48 (other bacterial diseases, not elsewhere classified) in ICD-10-CM. That’s a new home for the disease. In ICD-9-CM, the code for Legionnaires’ disease falls under diseases of the respiratory system (482.84, in case you’re interested).
The disease itself hasn’t changed. It’s just been moved from respiratory to infectious diseases.
We also get a second code for Legionnaires’ disease in ICD-10-CM: A48.2 (nonpneumonic Legionnaires’ disease [Pontiac fever]). We don’t have a code for Pontiac fever in ICD-9-CM.
Legionnaires’ disease is a type of pneumonia. Pontiac fever is a less severe, flu-like condition caused by the same bacteria.
Alex comes in to see Dr. Guts complaining of fatigue and tiredness, as well as some slight abdominal pain. After performing a complete exam and blood tests, Dr. Guts diagnoses Alex with a bleeding peptic ulcer.
Dr. Guts determines that Alex needs surgery to control the bleeding.
Dr. Guts has plenty of techniques to choose from to stop the bleeding. She can cauterize the ulcer or inject medication. In Alex’s case, she decided to clip the ulcer to stop the blood flow.
Generally, this surgery is performed in the outpatient setting, but our crack coders at Stitch ‘Em Up Hospital are coding it for ICD-10-PCS so they can compare inpatient and outpatient data.
So how are they coding this procedure?
We know we’re in the Medical and Surgical section (first character 0). We know we’re in the gastrointestinal body system (second character D).
You might remember that CMS struck a deal with the American Medical Association (AMA) to get AMA on board with ICD-10. For the first year of ICD-10 use, CMS will not deny or audit claims based solely on the specificity of diagnosis codes, as long as the codes on such claims are from the correct family of codes.
Unfortunately, CMS didn’t specify at the time what it meant by “family of codes.” Apparently, a lot of people raised questions about just how CMS’ plan would work because the agency released Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities. The document includes 13 questions and answers, including three focused on the family of codes.
Leprosy cases are surging in Florida, with new cases in the first half of 2015 nearing the average total for an entire year. The potential source of this explosion (to use the term very loosely) of cases: armadillos.
Don’t panic, though. Florida typically sees 10 cases of leprosy per year. In the first half of 2015, the number of cases has already reached nine. Nine people does not a real outbreak make, but it is enough to make the national and international news.
Officials are blaming contact with armadillos for the spike in leprosy cases. Personally, I’m not interested in shaking paws with an armadillo (or any wild animal for that matter), but some people just want to embrace nature.
Some armadillos also like to spit at people (usually when the armadillo is in a cage). Mycobacterium leprae bacteria, which causes leprosy, can be transmitted through spit.
Fortunately, leprosy is hard to contract (most people are actually immune to it). However, all nine people who contracted leprosy in Florida this year reported contact with armadillos and some nine-banded armadillos do carry leprosy. They are the only animals that do, by the way. Sadly, they do not also carry signs telling you they are leprosy positive.
Joe comes into the Fix ‘Em Up Clinic to see Dr. Bones for a problem with his knee. Joe tells Dr. Bones that his right knee locks up occasionally and he often has pain in his knee. Joe denies any traumatic injury. He tells Dr. Bones the knee will lock when he stands up after kneeling on the floor. He’s experienced the problem for almost a year.
Dr. Bones diagnoses Joe with a torn meniscus. But is Joe’s injury acute or chronic?
Meniscal tears are not always necessarily traumatic, and they’re not necessarily acute. According to Dr. Bones’ documentation, Joe has experienced problems with his knee for almost a year and Joe didn’t suffer any trauma at this time that caused him to seek treatment.
Dr. Bones doesn’t specify whether the injury is acute or chronic.
If you look in the ICD-10-CM Alphabetic Index under ”tear, meniscus,” it immediately gives us an S code for a traumatic injury. That makes the traumatic injury the default code.