Today we are going to talk about Chapters 19 and 20 (in the ICD-10-CM code book), but we're limiting our
discussion to Injuries and Fractures Part 1.
The reason for that is as you get into this chapter, you'll notice that, in addition to
coding the injury, we also have to code "external causes", which is Chapter 20 (in the ICD-10-CM code book).
I think it makes more sense to do them side by side.
I encourage you to get into the code book as soon as you can and start to look at all
the specificity.
When the number of codes in ICD-10-CM became published, the primary reason why there are
are so many codes is the "laterality", the left and right sides of the body and the "specificity", the
exact point in the body where the fracture happened.
The documentation that I have given you to code is very, very specific because that's
what we're shooting for.
But be aware that in the real world, you may not find that specificity, therefore your
codes are going to be less specific. Over time your clinical documentation coordinator
or whatever, C.D.I. or whatever his name or her name is in your facility, is going to
be working with the doctors trying to get them to read that X-ray in all its detail
and document accordingly, so you can code (to the) highest specificity.
I also have changed it up a bit from the way we've been doing these chapters because of
the number of guidelines.
I decided in this podcast I'm going to list the guideline, I'm going to give you an example
of that guideline, and then we're going to code it- just the injuries- and the next slide
will be adding the external cause codes.
You've been coding now for quite a while through the semester, so I expect you to be able to
find these codes with a little bit of guidance.
I strongly encourage you to save the Power points which you can download from the Content page,
Print them if that's what you need to do so you can review them for the test, as well
as just to know how to code injuries and fractures.
I also suggest that you would cover the answers (on the Power Points) and try to find these codes on your own so
that you can do so if you were asked to do that on a test.
Alright, let's jump in.
Our first slide has to do with the Chapter 19 overview.
Chapter 19 uses the "S" section, that's "S" as in Sam, section for different types of injuries related
to single body regions and the "T", "T" for Tom, section to cover injuries to unspecified body
regions, as well as any burns, poisonings, adverse effects, complications of care, different
consequences that are caused by something external to the body.
There's an instructional note at the beginning of Chapter 19 which tells us to use secondary
codes from Chapter 20 to indicate the cause of injury.
Those Chapter 20 codes are never the principal (diagnosis). So your injury code is going to be the principal (diagnosis)
and your Chapter 20 external causes is going to be a secondary code.
There is also an instructional note at the beginning of Chapter 19 advising the coder
to use an additional code identifying any additional retained foreign body, if that's
applicable to the case that you're coding, and that is Z18.- code.
Chapter 19 has extensive "inclusion" and "exclusion" notes, which makes for very long and complicated
code descriptions.
It's important that you take the time to read those because otherwise you are going to be
breaking some of those "Excludes 1" notes.
Fractures make extensive use of the seventh character value, which is a lot more detailed
than what we've done so far in this course.
Thus far, we have looked at "A" for initial encounter, "D" for subsequent encounter, and "S" for
sequelae.
Many of our codes are going to be far more detailed than that now and you will be finding
that little pink box that advises you which seventh character choices you have just after
the category code.
So whenever the Alphabetical Index takes you to a code, for example, S52.111-, you
are going to go to that code but you're also going to look back at the (beginning of the) S52 category to
see the little pink box and what options you have there for seventh character.
You know in an injury code you're going to be using that seventh character, so it's important
that you only use the options that are available for that specific code.
This is an example of an image that I took off of Google images just to remind us of
the types of bone fractures we might read about.
I encourage you to look at Google not only for the bones but to also see the different
parts of the arm. This is an example that I'm taking here where you can see the radius bone. that
If the palm is up, the radius bone is on the outside of the arm and then you can see the
anatomy of the elbow.
You can see where the radius fits into that elbow joint.
There's so many images on Google images.
I don't want you to get lost in them but I think it's important review for you.
You can also use your anatomy textbooks.
Okay, now let's talk a little bit about Chapter 20.
There is an Index of External Causes. just after the Table of Drugs and Chemicals.
If you recall there's an
Alphabetical Index, then the Neoplasm table, then the Table of
Drugs and Chemicals, then the Index of External Causes.
You may have put a tab on it in the very beginning of the semester.
If you go to Chapter 20 in your code book, there is a list of blocks that tells you what
is contained within this chapter and under transport accidents, which is quite a large
category, there's a lengthy instructional note that defines the different transport
vehicles.
I mentioned a little bit earlier, just a reminder again, just to always look at the beginning
of a category to be sure that you are only using the seventh character codes that are
an option for any specific code (within that category) you're using.
In Chapter 20, it's only certain codes that uses a seventh character.
In Chapter 19, almost all codes use a seventh character, but not all of them.
External cause of morbidity codes are used with injury codes to provide information about
how that injury occurred, what caused it, was it intentional or accidental (if you know that), and the place
it occurred, the status i.e. is it a military person or a civilian person? Is the patient
working, was the patient working when he or she got hurt? Were they in the military but
on their off time, off duty time?
All those status statistics are kept by the hospital, reported to certain entities, who
knows why.
I'm assuming they use them to report on how often people get injured when they're working
in a certain field or doing a certain activity.
Speaking of activity, when an activity contributes to the injury, there's an activity code, category
Y93 that is used to describe the activity.
These external cause codes are assigned based upon physician documentation.
If the physician does not document external cause information, coders can use documentation
from documentation from non-physicians.
But if there is ever a conflict between what the physician is saying and what the non-physician
is stating, then we have to use the physician's documentation as our source.
The assignment of the seventh character for the external cause code should match the seventh
seventh character of the injury code.
There are times when that is questionable and I think when we get our next code updates
October 1st, some of those things are going to be taken care of.
That's what I'm hoping anyway and when that happens, and I'm aware of it, I will definitely
make you aware as I code these.
There is a hierarchy when you are sequencing external cause codes and this is the way they
they are ordered.
A code for external cause for child and adult abuse takes priority over all other external
cause codes.
The terrorism external cause codes takes priority over all external cause codes, except child
and adult abuse.
Cataclysmic events like hurricanes, tornado, floods, blizzard, storm, those type of things,
takes priority over all other external cause codes except for child and adult abuse and
terrorism.
So do you see how this hierarchy is ordered?
Transport accidents take priority over all other external causes, except child and adult
abuse, terrorism, and the cataclysmic events.
The first listed external cause code should correspond to the most serious diagnosis that
is due to an assault, accident, or self harm, following the same order of hierarchy.
I have to depend on you to go back to your Coding Handbook and review these in great
detail.
I cannot, in a podcast, spend a lot of time on them because they just get too long but
here is the case in point where you just need to make sure you go back to the Coding handbook
Handbook and read these.
The first coding guideline I'm going to refer to is the application of the seventh character.
I've given you a diagnostic statement here in purple.
I have highlighted what happened, how he got hurt, and his injury.
And I have in the coding column just given you the injury code; the path and the rationale
is there on the right.
And in the following slide, I add those external cause codes where the cause was a fall from
from the balcony, the place is at the student's home, the child's home, and the activity is rough-housing with
with his friends.
So, this gives us all of our codes now, our injury code and our external cause codes.
Here's an example of that seventh character we talk about where it's not "D", as in subsequent
subsequent encounter.
We've got more information given to us.
The top diagnostic statement, the radius is healing but not as quickly.
So you're going to get a delayed healing code and then the second diagnostic statement
is a nonunion, which is a different seventh character, for
subsequent encounter for fracture with nonunion.
Coding of injuries I've highlighted in purple.
All the terms that we will be using when we code this diagnostic statement.
As a reminder, I encourage you to try and find these codes on your own, either covering
up the answers in the pathway so that you are definitely sure you know how to do that.
So here we have the injury codes for this particular diagnostic statement.
I've explained to you why I chose the characters that I chose and here is the same scenario
now we're highlighting the external causes.
Driver of a motorcycle with an accident occurring on a state road.
Thank you for your attention.
Watch out now for Injuries and Fractures Part 2.