Exercise 23.1 number three is traumatic arthritis due to an old traumatic dislocation.
Now, if you look at Arthropathy traumatic ankle, you get an M code.
You know this is an old injury, so an M code is correct.
And there is your pathway, you’re going to code the arthritis, and you’re going
to code the dislocation of the ankle.
But the fifth character ‘S’ for Sequela because it’s an old injury.
Sequela is the appropriate seventh character.
Many times, in coding, this chapter, you’re going to see notes in the alphabetic index
that say See, so you kind of flipping back and forth, looking quite a bit.
Once you’ve coded for a while, you know when you’ve seen something, just to skip
that first main term, and go straight to the second term, because you’ve coded it enough
that you recognize that.
In this case, that – it does not a seventh character, you’re looking at a sixth character,
and number two indicates it is the left ankle.
Exercise 23.2 number three.
What’s interesting here, and I wanted to bring this one as an example, the index, when
you look up, derangement, the knee, gives you an M code, and we know that can’t be
correct, because it’s a current injury, see right here, current.
And therefore, it has to be chapter 19 S code.
So, if you look again, you do see that there’s a subterm “current injury”.
You just don’t see it right away.
When you find it, it gives you that S code.
Actually, it says “see dislocation.
Again, if you go to the next step, dislocation knee, you get seventh character A is your
initial encounter, and the sixth character, four.
In this case, it is the right knee.
The other things I found – I want you to use this particular one.
The code is not correct.
It’s one of those that gets you in the neighborhood, but not to the exact code.
S83.106 is a specified knee, and we know from the diagnosis statement, it’s a right knee.
So, we’re going to look around our codes and find 283.104 indicates it’s the right
knee.
And again, seventh character is A. Exercise 23.4 number three is acute myelitis.
In ICD-9, which many of you don’t know, but there was an assumed linkage between osteomyelitis
and diabetes, that is not true in ICD-10.
So, the old coders happened to get used to not looking at things the same way.
Because it is a diabetic problem, diabetes codes are going to go before the osteomyelitis
code.
The osteomyelitis is a complication.
The answer key for the textbook, which I have did not include this E-11.69 code, but I think
it needs to be there.
Because this is only talking about arthropathy.
The fact that that person has diabetes – has osteomyelitis is significant, so I think that
should be included.
So, that’s why I included that E11.69 as the complication code for diabetes.
In case you don’t know, osteomyelitis is an infection of the bone.
Or an inflammation or infection of the bone, so it can be quite serious for someone who
is not feeling well.
So, that’s why that – I think that needs to be included as your codes.
Exercise 23.4 number five.
It’s a nonunion fracture, so that’s where you’re going to use that seventh character
K here, for subsequent encounter nonunion.
Remember, subsequent encounter is when the patient is no longer receiving active treatment.
They’re in the routine healing phase, and this case, the healing is not routine, and
the patient is presented with a nonunion of that fracture.
Exercise 23.4 number twelve.
I included a disc herniation and spondylosis with radiculopathy.
Whenever you’re coding the general population, you’re going to code a lot of spondylosis.
And many times, your excludes one and excludes two instructional notes give you information
about the types of spondylosis.
Be sure you’re following those very carefully.
Be mindful that all the exercises that are covered in this PowerPoint do not address
all the many guidelines that we have to use.
Exam questions can relate to all the guidelines covered in the chapters planned for each week.
Always follow the assignment schedule with regard to specific Chapter assignments.
Post any questions in the discussion board, along with the path that you used to try to
solve this problem, and I can answer it so that everyone can share in that discussion.
Thank you so much, and have a good day.