Injury, poisoning and certain other consequences of external causes (S00-T88)

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1 Injury, poisoning and certain other consequences of external causes (S00-T88) Presented by Andy Bhatia, DPM Webinar 6: Thursday, April 17,

2 APMA Educational Information: ICD-10 Webinars Register for upcoming webinars View archived recordings Download PDF versions of each presentation apma.org/icd10ishere or apma.org/webinars Coding Resource Center apmacodingrc.org Questions Contact the Health Policy and Practice Department or

3 ICD-10-CM Resources 3

APMA Coding Resource Center www.apmacodingrc.

4 APMA Coding Resource Center ICD-9 to ICD-10 crosswalks are now available. 4

5 ICD-10-CM Guidelines - CHAPTER 19 Injury, poisoning and certain other consequences of external causes (S00-T88) The S section provides codes for the various types of injuries related to single body regions; The T section covers injuries to unspecified body regions as well as poisonings and certain other consequences of external causes. 5

6 ICD-10-CM Guidelines - CHAPTER 19 S70 S79 Injuries to the hip and thigh S80 S89 Injuries to the knee and lower leg S90 S99 Injuries to the ankle and foot T07 Injuries involving multiple body regions T14 Injury of unspecified body region T15 T19 Effects of foreign body entering through natural orifice 6

7 ICD-10-CM Guidelines - CHAPTER 19 T20-T32 Burns and corrosions T33 T34 Frostbite T36 T50 Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances T51 T65 Toxic effects of substances chiefly non-medicinal as to source 7

8 ICD-10-CM Guidelines - CHAPTER 19 T66 T78 Other and unspecified effects of external causes T79 Certain early complications of trauma T80 T88 Complications of surgical and medical care, not elsewhere classified 8

9 GUIDELINES: Chapter 19 Most categories in Chapter 19 have seventh character extensions that are required for each applicable code, and most categories have three extensions (with the exception of fractures): A, Initial encounter D, Subsequent encounter S, Sequela 9

10 GUIDELINES: Chapter 19 The S extension identifies the injury responsible for the sequela. The specific type of sequela (e.g., scar) is sequenced first, followed by the injury code. Sequela terminology in ICD-10-CM replaces the late effects categories ( ) in ICD-9-CM. 10

11 GUIDELINES: Chapter 19 - Fracture Coding ICD-10-CM fracture codes can indicate the fracture type (e.g., greenstick, transverse, oblique, spiral, comminuted, segmental), specific anatomical site, whether the fracture is displaced or not, laterality, routine versus delayed healing, nonunions, and malunions. Laterality and type of encounter (initial, subsequent, sequela) are significant components of the code expansion. 11

12 GUIDELINES: Chapter 19 The fracture extensions are expanded to include: A, Initial encounter for closed fracture B, Initial encounter for open fracture D, Subsequent encounter for fracture with routine healing G, Subsequent encounter for fracture with delayed healing K, Subsequent encounter for fracture with nonunion P, Subsequent encounter for fracture with malunion S, Sequela 12

13 GUIDELINES: Chapter 19 In ICD-10-CM a fracture not indicated as displaced or nondisplaced should be coded to displaced, and a fracture not designated as open or closed should be coded to closed. 13

14 GUIDELINES: Chapter 19 - Poisoning, Adverse Effects, and Underdosing of Drugs Codes in categories T36 T65 are combination codes that include substances related to adverse effects, poisonings, toxic effects, and underdosing, as well as the external cause. No additional external cause code is required. ICD-10-CM includes a table of drugs and chemicals 14

15 GUIDELINES: Chapter 19 - Poisoning, Adverse Effects, and Underdosing of Drugs ICD-10-CM includes a table of drugs and chemicals with four columns with headings related to poisonings. Accidental (unintentional) Intentional (self-harm) Due to assault Undetermined There is also a fifth column with the heading Adverse Effects and a sixth column with the heading Underdosing. 15

16 GUIDELINES: Chapter 19 - Burns and Corrosions Burn codes apply to thermal burns (except sunburns) that come from a heat source, such as fire or hot appliance. They include electricity and radiation burns. Corrosions are burns due to chemicals. The guidelines are the same for burns and corrosions. 16

17 GUIDELINES: Chapter 19 - Burns and Corrosions Current burns (T20 T25) are classified by depth, extent, and agent (X code). Burns are classified by depth as first degree (erythema), second degree (blistering), and third degree (full-thickness involvement). Burns of the eye and internal organs (T26 T28) are classified by site, not by degree. Use an additional code for the infection. When coding burns, separate codes for each burn site should be assigned. 17

18 Bite on foot 18

19 SUBJECTIVE Pt is a 42 y/o Male that presents for suspected spider bite to dorsal right foot. He is s/p 3 days. He went to an urgent care center immediately and had a drainage done of open abscess at that time by Dr. Dre. Pt did not accurately recall exactly if it was a spider because he was extremely drunk and walking around his garage and felt a sharp pain. He has been doing dressings daily with gentamicin cream and dry dressing. He is taking Doxycycline, and for pain, Ibuprofen. He thinks he is doing better. 19

20 HISTORY Allergies : No Known Allergies Current medication: Doxycycline and Ibuprofen for current situation Past medical/surgical history: unremarkable Social history: 1 pack of cigarettes a day x 20 years. 12 pack of beer daily Family history: Liver disease- mother 20

21 Review of Systems Systemic: No fever, no chills. GI : No nausea or vomiting. Endocrine: No excessive sweating. Musculoskeletal: back pain due to riding mechanical bull yesterday. 21

22 OBJECTIVE General Appearance: Alert. Oriented to time, place, and person. In no acute distress. Arterial Pulses: Posterior tibialis pulses were normal. Dorsalis pedis pulse on Left was normal, on Right foot not palpated due to wound. No evidence of hematoma. Edema: +2 non-pitting Skin: Foot, right: : Slightly warm, slight tenderness on palpation. No odor, slight serous drainage. 22

23 OBJECTIVE cont. Neurologic status: no numbness noted and intact DTR bilateral. Physical findings: Height : 5ft 10 inches Weight : 140 pounds; BP : 115/80; Pulse : 65 23

24 ASSESSMENT Bite, spider, healing wound, no complication 24

25 PLAN Continue current plan of care. Finish antibiotic. Return in 7 days. 25

26 ICD Open wound of foot except toe(s) alone, without mention of complication Insect bite, nonvenomous, of foot and toe(s), without mention of infection E906.4 Bite of nonvenomous arthropod 26

27 ICD 10 mapping for Injury, poisoning and certain other consequences of external causes S00-T88 Injuries to the ankle and foot S90-S99 S91 Open wound of ankle, foot and toes 27

28 ICD- 10 mapping for S91.3 Open wound of foot S91.35 Open bite of foot S Open bite, right foot S91.351A Open bite, right foot, initial encounter 28

29 ICD 10 mapping for S00-T88 Injury, poisoning and certain other consequences of external causes S90-S99 Injuries to the ankle and foot S90 Superficial injury of ankle, foot and toes 29

30 ICD- 10 mapping for S90.8 Other superficial injuries of foot S90.86 Insect bite (nonvenomous) of foot S Insect bite (nonvenomous), right foot S90.861A Insect bite (nonvenomous), right foot, initial encounter 30

31 Similarly, the final code can be arrived at as such: Chapter 20> External causes of morbidity V00- Y99 > Exposure to animate mechanical forces W50-W64 > Bitten or stung by nonvenomous insect and other nonvenomous arthropods W57- W57.XXXA Bitten or stung by nonvenomous insect and other nonvenomous arthropods, initial encounter 31

32 Another method of getting to the same ICD -10 codes is to use the alphabetical Index. 32

33 ICD-10 Diagnosis Index 2013 ICD-10-CM Alpha Index 'A' terms (702) 'B' terms (395) 'C' terms (716) 'D' terms (408) 'E' terms (347) 'F' terms (261) 'G' terms (265) 'H' terms (559) 'I' terms (208) 'J' terms (32) 'K' terms (106) 'L' terms (331) 'M' terms (593) 'N' terms (202) 'O' terms (245) 'Ö' terms (1) 'P' terms (852) 'Q' terms (14) 'R' terms (253) 'S' terms (684) 'T' terms (368) 'U' terms (109) 'V' terms (148) 'W' terms (107) 'X' terms (18) 'Y' terms (7) 'Z' terms (12) 33

34 Under B, you will find: Bite(s) (animal) (human) Under that, looking alphabetically you will find: Foot (except toe(s) alone) S This leads to: S Open bite, right foot And finally to: S91.351A Open bite, right foot, initial encounter 34

35 Similarly you have the ICD-10-CM External Cause Alpha Index 'A' terms (22) 'B' terms (20) 'C' terms (29) 'D' terms (17) 'E' terms (15) 'F' terms (21) 'G' terms (2) 'H' terms (15) 'I' terms (19) 'J' terms (2) 'K' terms (4) 'L' terms (11) 'M' terms (16) 'N' terms (5) 'O' terms (6) 'P' terms (18) 'R' terms (12) 'S' terms (41) 'T' terms (18) 'U' terms (2) 'V' terms (4) 'W' terms (9) 35

36 Under B, you will find: Bite, bitten by Under that, looking alphabetically you will find: Spider (nonvenomous) W57 Bitten or stung by nonvenomous insect and other nonvenomous arthropods This leads to: W57.XXXA Bitten or stung by nonvenomous insect and other nonvenomous arthropods, initial encounter 36

37 SUBSEQUENT VISIT CODING S91.351D Open bite, right foot, subsequent encounter S90.861D Insect bite (nonvenomous), right foot, subsequent encounter W57.XXXD Bitten or stung by nonvenomous insect and other nonvenomous arthropods, subsequent encounter 37

38 SEQUALAE CODING S91.351S Open bite, right foot, sequela S90.861S Insect bite (nonvenomous), right foot, sequela W57.XXXS Bitten or stung by nonvenomous insect and other nonvenomous arthropods, sequela Extension S, sequela, is used for complications or conditions that arise as a direct result of an injury, such as scar formation after a burn. The scars are sequela of the burn. When using extension S, it is necessary to use both the injury code that precipitated the sequela and the code for the sequela itself. The S is added only to the injury code, not the sequela code. 38

39 Comparing ICD-9 and ICD-10 ICD Open wound of foot except toe(s) alone, without mention of complication ICD-10 S91.351A Open bite, right foot, initial encounter Insect bite, nonvenomous, of foot and toe(s), without mention of infection E906.4 Bite of nonvenomous arthropod S90.861A Insect bite (nonvenomous), right foot, initial encounter W57.XXXA Bitten or stung by nonvenomous insect and other nonvenomous arthropods, initial encounter 39

40 Phalanx Fracture with Laceration 40

41 SUBJECTIVE 21 years old female presents with a chief complaint of injury to her right great toe. She stubbed her right great toe severely against the chair while in the kitchen. This caused great pain and discomfort and it soon began to swell and turn red, black, and blue. There was slight temporary bleeding. It is very sore to put weight on the foot and she cannot get a shoe on this foot. The injury occurred while cooking at the patient's home. This occurred this afternoon 41

42 HISTORY Past Medical History: None Medication: Multivitamin daily Allergies: Sulfa Family history: Mother has diabetes Social history: non smoker and social alcohol use. She does not claim to be drinking at the time of injury ROS: Musculoskeletal: (+) right foot pain 42

43 OBJECTIVE Vital Signs: 5ft 9 inches 137 pounds BP 110/68, pulse 64, respirations 24, temperature 98 Patient is well oriented to time and place and is able to communicate with me about her problems. Vascular examination shows palpable pulses bilateral. Neurologic; DTR are intact and tactile sensation is good Dermatologic evaluation reveals swelling and discoloration around the right great toe. The right hallux is very swollen and tender to touch all over. The tip of the toe has some avulsion of the skin. It is partial thickness. The nail has also been damaged severely. 43

44 TESTS X-Ray, 3 views of right foot with toe elevated showed a closed nondisplaced fracture of distal phalanx of right great toe. The general appearance of the bone is normal for the age and gender of the patient. 44

45 ASSESSMENT Closed Nondisplaced fracture of distal phalanx of right great toe Laceration of right great toe, partial thickness laceration 45

46 PLAN Discussed the need for adequate immobilization because of fracture and needing wound care to laceration. Wound was cleansed and dressed with gentamicin cream and dry dressing. Patient consents to walking boot immobilization which was dispensed with instructions-- non-pneumatic, without joints, with interface material, prefabricated, with fitting and adjustment. Instructed to walk as less as possible, elevation, and a Rx for Ibuprofen. 46

47 PLAN Follow Up: Patient to return to office in 3 days for evaluation and wound care, to call if increased pain, swelling or discomfort or questions. Monitor for s/s of infection Medication: Ibuprofen 800 mg Sig: 1 q8h prn pain with food. 47

48 ICD Closed fracture of one or more phalanges of foot Open wound of toe(s), without mention of complication 48

49 ICD 10 mapping for Injury, poisoning and certain other consequences of external causes S00-T88 Injuries to the ankle and foot S90-S99 Fracture of foot and toe, except ankle S92-49

50 ICD- 10 mapping for S92.424A S92.4 Fracture of great toe S92.42 Fracture of distal phalanx of great toe S Nondisplaced fracture of distal phalanx of right great toe Nondisplaced fracture of distal phalanx of right great toe, initial encounter for closed fracture 50

51 ICD 10 mapping for Injury, poisoning and certain other consequences of external causes S00-T88 Injuries to the ankle and foot S90-S99 S91 Open wound of ankle, foot and toes 51

52 ICD- 10 mapping for S91.211A S91.2 Open wound of toe with damage to nail S91.21 Laceration without foreign body of toe with damage to nail S Laceration without foreign body of right great toe with damage to nail Laceration without foreign body of right great toe with damage to nail, initial encounter 52

53 Cause of Injury ICD-10 code This final code can be arrived at by the following manner: Chapter 20 > External causes of morbidity V00- Y99 > Exposure to inanimate mechanical forces W20-W49 > Striking against or struck by other objects W22- W22.03XA Walked into furniture, initial encounter 53

54 SUBSEQUENT VISIT CODING S92.424D subsequent encounter for fracture with routine healing S92.424G subsequent encounter for fracture with delayed healing S92.424K subsequent encounter for fracture with nonunion S92.424P subsequent encounter for fracture with malunion 54

55 SUBSEQUENT VISIT CODING S91.211D Laceration without foreign body of right great toe with damage to nail, subsequent encounter W22.03XD Walked into furniture, subsequent encounter 55

56 SEQUALAE CODING S92.424S Nondisplaced fracture of distal phalanx of right great toe, sequela S91.211S Laceration without foreign body of right great toe with damage to nail, sequela W22.03XS Walked into furniture, sequela Extension S, sequela, is used for complications or conditions that arise as a direct result of an injury, such as scar formation after a burn. The scars are sequela of the burn. When using extension S, it is necessary to use both the injury code that precipitated the sequela and the code for the sequela itself. The S is added only to the injury code, not the sequela code. 56

57 Comparing ICD-9 and ICD-10 ICD Closed fracture of one or more phalanges of foot Open wound of toe(s), without mention of complication ICD-10 S92.424A Nondisplaced fracture of distal phalanx of right great toe, initial encounter for closed fracture S91.211A Laceration without foreign body of right great toe with damage to nail, initial encounter W22.03XA Walked into furniture, initial encounter 57

58 Questions? 58

Diseases of the Musculoskeletal System and Connective Tissue M00 M50 (Part 2)

Diseases of the Musculoskeletal System and Connective Tissue M00 M50 (Part 2) Presented by Lawrence Santi, DPM, FASPS Webinar 4b: Thursday, March 6, 2014 1 APMA Educational Information: ICD-10 Webinars