GOOD MORNING! How are you? - PowerPoint Presentation

1. GOOD MORNING!How are you?Are you enjoying the course?

2. Chapters 19 and 20 - Module 25Coding of External CausesDr. Nandalal Wijesekera (MBBS, MSc., MD)Consultant MCCD certification & ICD codingVital Strategies

3. Module 25Injury, Poisoning & Certain other Consequences of external causes (Chapter 19) & External Causes of Morbidity & Mortality (Chapter 20)Page 218 of your Workbook

4. Chapter 19 & 20Chapter 19 Injury, poisoning and certain other consequences of external causes (S00 - T98) – Tabular list (volume 1)Chapter 20 External causes of morbidity & mortality (V01 - Y98) -Tabular list (volume 1)

5. The external cause conceptThe use of Chapter 20 codes permits the classification of environmental events, circumstances & conditions as the cause of injury, poisoning & other adverse effects

6. The external cause concept …When multiple coding, a Chapter 20 code should always be assigned with a Chapter 19 code Example 2 … That is, a code describing how the injury(s) occurred as well as the injury code(s) will be assigned

7. An overview of chapter 19Two letters S & T (Vol. 1)S - section is for coding of different types of injuries related to single body regionsT - section is for multiple or unspecified body sites, poisoning & other consequences of external causes

8. Important points for chapter 19Categories range from S00-T98Of the 199 available categories 195 have been allocatedThere are 21 blocksBlocks S00-S99, at the 3 character level injuries are classified by site of injury, e.g. head, arms The 4th character level indicates the type of injury that occurred, e.g. fracture, open wound

9. Important points for chapter 19 ...Codes in the range T00-T98 (Vol. 1) are used to code all other trauma, e.g. burns, complications of surgery, poisoningsWhen multiple coding, all injuries should be coded, avoid the use of 'multiple' type codes

10. “with” - means involvement of both sites“and” - means involvement of either or both sitesImportant points for chapter 19...

11. Definition of injuries – See volume 1Superficial InjuryOpen WoundFractureDislocation, sprain & strainCrushing injuryTraumatic amputationImportant points for chapter 19 ...

12. Optional codes0 - closed fractures1 - open fracturesIf it is unspecified classified as closedImportant points for chapter 19 ...

13. Example 1Open compound fracture of the neck of the femur Look up Fracture in the index (vol. 3) -femur, femoral - -neck S72.0S72 Fracture of femur (Vol.1)Code S72.01 (1 as the # is compound meaning open)

14. Burns.0 Unspecified degree.1 First degree – erythema.2 Second degree - blisters, epidermal loss.3 Third degree - deep necrosis of underlying tissues, full- thickness skin loss

15. Example 2Second degree Burns of face, arms & body due to flameLook up Burns in the index(Vol. 3) - multiple body regions T29.0 - -second degree T29.2T29 Burns & corrosions of multiple body regions (Vol. 1)Code to T29.2

16. Example 3Poisoning due to ingestion of plant alkaloid Look up Poisoning in the index (Vol. 3) - Plants, noxious T62.2T62 Toxic effect of other noxious substances eaten as food (Vol. 1)Code to T62.2

17. Example 4Peripheral neuritis following pesticide poisoning 5 years ago Look up Sequelae in the index (Vol. 3) - Poisoning due to - - Non medicinal substances T97 T97 Sequelae of toxic effect of substances chiefly non medicinal as to source (Vol.1)Code to T97

18. An overview of chapter 20Chapter 20 of volume 1Four letters V, W, X & YPlace of occurrence code (4th character)Activity code (5th character)

19. Important points for chapter 20Four letters of the alphabet - V,W,X &Y - have been assigned to this chapter making it the largest in ICD-10Categories range from V01-Y98Of the 400 available categories 372 have been used8 major blocks

20. Important points for chapter 20 …The Chapter includes Place of occurrence codes, which are 4th character subdivisions used to identify the place where an injury occurredThey are to be used with categories W00-Y34 (except Y06 and Y07) (vol. 1)

21. Place of Occurrence Code: W00-Y34 (except Y06 & Y07).0 - Home.1 - Residential Institution .2 - School, other institution, public administrative area.3 - Sports & athletic area.4 - Street & Highway.5 - Trade & service area.6 - Industrial & construction area.7 - Farms.8 - Other specified place.9 - Unspecified place

22. Important points for chapter 20 ...An Activity code is also provided for optional use in a supplementary character position with categories V01-Y34 to indicate the activity the injured person was involved in at the time of the injury. (Vol. 1)

23. Activity code for V01 - Y340 - While engaged in sports activity1 - While engaged in leisure activity2 - While working for income3 - While engaged in other types of work4 - While resting, sleeping, eating or engaging in other vital activities8 - While engaged in other specified activities9 - While engaged in other unspecified activities

24. Chapter 20 codes can also be assigned with codes from Chapter 1-17 to identify the external cause of a condition, e.g. dermatitis due to solventsImportant points for chapter 20 ...

25. Chapter 20 codes are never assigned as the main condition code for morbidity coding For mortality coding the Chapter 20 code is the code assigned for the Underlying Cause of Death (UCOD)Important points for chapter 20 ...

26. Definitions related to transport accidents. Please refer Tabular list (Vol. 1) Transport Accident Public highway Traffic accident Non Traffic Accident Pedestrian Driver Important points for chapter 20 ...

27. Definitions related to transport accidents… Passenger A person on outside of vehicle Pedal cycle Pedal cyclist Motor cycle Motor cycle Three wheeled motor vehicle CarImportant points for chapter 20 ...

28. Definitions related to transport accidents… Pick-up truck or van Heavy transport vehicle Bus Railway train etc etc …………….. …… …. AircraftImportant points for chapter 20 ...

29. Classification & coding instructions for transport accidents (Please refer to volume 1) Assumptions Order of Precedence Victim not specified victim’s role is not indicated Collision Subsequent collision Land transport accidentsImportant points for chapter 20 ...

30. Most of the V01-V79 (Vol. 1) are classified at the 3 character level by the mode of transport of the injured person & at the 4th character level according to the position of the person in the motor vehicleAlways look for the 4th character at the beginning of the block or chapterImportant points for chapter 20 ...

31. X60-X84 (volume 1) Intentional self-harm, are incidents determined as being suicide or self-inflicted injuriesImportant points for chapter 20 ...

32. The Table of Drugs & Chemicals, found at the back of the Alphabetical Index (Vol. 3), guides the coder to the correct codes to describe poisonings by drugs & chemicalsImportant points for chapter 20 ...

33. Table of Drugs & ChemicalsName of the substanceChapter 19 codeAccidentalIntentional self-harmUndetermined intentAdverse effect in therapeutic use

34. Y10-Y34 (Vol. 1) Event of undetermined intent, includes injuries where it is undetermined whether the person was accidentally injured or the injury was purposely inflictedImportant points for chapter 20 ...

35. Example 1Compound fracture of the shaft of the femur due to fall from a heightLook up Fracture in the index (Vol. 3) - femur, femoral - -shaft S72.3(S72 Fracture of femur Vol. 1) Code S72.31 (1 for open wound)

36. Example 1 … Compound fracture of the shaft of the femur due to fall from a height …Look up Fall in the index (Vol. 3) - from, off -- high place NEC W17-Refer to Vol. 1 (Tabular list) W17.-, then look at ‘see at the beginning of chapter for 4th character subdivisions’Code W17.99 (unspecified place, unspecified activity)

37. Example 2Second degree Burns of face, arms & body due to camp fireLook up Burns in the index (Vol. 3) - multiple body regions - - second degree T29.2T29 Burns & corrosions of multiple body regions (Vol. 1)Code T29.2

38. Example 2 …Second degree Burns of face, arms and body due to camp fire …We need a chapter 20 code also THE EXTERNAL CAUSE CONCEPT …Look up Fire (see exposure) (section II of the index/vol.3)Look up Exposure in the index vol. 3 - fire -- camp fire X03.-Code X03.89Vol. 1 X03.-, (see at the beginning of chapter for 4th character subdivisions) Other specified places – Campsite .8Activity – During unspecified activity - 9

39. Exercise 13Patient admitted with scar contractures of wrist wounds as a late effect of trying to slash her wrist in a suicide attempt 6 months ago Look up Scar in the index, section I (Vol. 3) Scar, Scarring L90.5Look up Late effect in the index section II (Vol. 3) – see SequelaeLook up Sequelae in the index section II (Vol. 3)Sequelae - wound, open -- limb --- upper T92.0

40. Exercise 13 …Patient admitted with scar…We need to find the external cause also Look up sequelae in the Index (Vol. 3)Sequelae -Suicide (attempt) Y87.0 (Vol. 1)Code to L90.5, T92.0, Y87.0

41. HintsExercise No 11, 12 & 13 have three codes eachRest have two codes eachLeave out ex. 10

42. Answers for module 251. S31.7, X99.522. T81.6, Y61.03. S06.20, W06.044. T88.5, Y48.45. S02.10, V80.06. T92.1, Y867. S93.4, W51.808. S09.2, W27.09

43. Answers for module …9. S82.40, V18.0910. S83.2 , X50.30 or X50.3211. S66.0, S61.0, W26.8112. S72.30, S82.21, V23.413. L90.5, T92.0, Y87.014. T42.4, X61.0915. T24.2, X00.09

44. Thank you!

45. ANSWERS FOR Ex 1Multiple lacerations to abdomen, inflicted by a knife during a fight in a bar. The victim was a bar attendant in the barLook up laceration in the Index (Volume 3)Laceration (see also Wound, open)As there is no listing under Laceration for abdomen, we need to refer to Wound, open in the Index (Volume 3)  Wound, open - multiple - - abdomen, lower back and pelvis -> S31.7

46. ANSWERS FOR Ex 1… We can now code the external cause of the injury (that is, how the injury occurred). In this case the wounds were 'inflicted by a knife in a fight in a bar'. Look up fight in the Index under External Causes of Injury section (Volume 3) Fight (hand)(fists)(foot) (see also Assault, fight) Y04.-Y04 does not cover fight with a knife, therefore we need to refer to Assault, fight in the External Causes of injury section,(Volume 3), to find fight with a knife.

47. ANSWERS FOR Ex 1 …  Assault - fight - - with weapon - - - cutting or piercing -> X99.- The .- at the end of the code indicates that the coder must assign a 4th digit. At the beginning of the X85-Y09 section there is a note referring the coder to pages 1013-1017, 982 for the 4th character subdivision. These pages list the places of occurrence for injuries - in other words, where they happened. We need to select from this section an appropriate code for bar. We will select .5 Trade & service area 

48. ANSWERS FOR Ex 1…As well, X99.- is in the range of codes that require an activity code to be selectedTurn to Vol. 1 & determine the correct activity code. We know the victim was a bar attendant at the time of the incident, & we assume he was working at the time of the injury, so the correct activity code is 2The complete external cause code for this case is X99.52

49. ANSWERS FOR Ex 2Peritonitis as a result of swab being left in wound, following operation to remove an appendixLook up Peritonitis in the Index (Volume 3)Peritonitis- due to foreign substance accidentally left during a procedure (chemical)(powder)(talc) -> T81.6You may also choose to code an External Cause to indicate that the injury was caused by a mistake during a procedure. In this cause the swab is considered a foreign body

50. ANSWERS FOR Ex 2…Look up foreign body in the External Causes Index (Volume 3).Foreign body- operation wound (left in) (see also Misadventure, foreign object, by specified type of procedure) -> Y61.9Misadventure, -foreign object left in body -- surgical operationY61.0

51. ANSWERS FOR Ex 3Cerebral contusion due to fall from bed onto floor, whilst sleeping, at homeLook up contusion in the Index (Volume 3)  Contusion - cerebral -> S06.2Refer to page 900 of the Tabular List (Volume 1). At the beginning of the S06 rubric is a list of optional fifth character subdivisions to indicate if the contusion occurred with or without open intracranial wound. As there is no mention of open intracranial wound in our diagnosis, we would use 0 in the fifth character position. Our code for cerebral contusion would be S06.20 

52. ANSWERS FOR Ex 3…For the external cause of the injury, we look up fall in the Index (Volume 3).  Fall - bed -> W06.-The .- indicates that more digits are required to complete this code. The additional codes are the activity code and the place of occurrence code. Refer to volume 1 for the place of occurrence code first. The correct code would be .0 for home. Refer Vol. 1 for the activity code. The person was sleeping at the time of the accident, so the code to use would be a 4. Therefore the complete external cause code for this case would be W06.04

53. ANSWERS FOR Ex 4Adverse reaction to anestheticLook up Reaction in the Index (Volume 3) Reaction- anesthesia - see Anesthesia, complication Anesthesia- complication or reaction NEC (see also Complications, anesthesia) -> T88.5Complications- anesthesia NEC -> T88.5 

54. ANSWERS FOR Ex 4 …Because we do not know any more information about the nature of the adverse reaction or the type of operation being performed we cannot use a more specific injury code. It is possible to add an external cause code to specify that the patient had an abnormal reaction to an anesthetic agent. Look up the Table of Drugs and Chemicals (volume 3). Anesthetic NEC - see under adverse effect in therapeutic use -> Y48.4. If you refer to volume 1 for Place of occurrence you will note that a place of occurrence code is not required for this code.

55. ANSWERS FOR Ex 5Jockey fractured his temporal bone from being thrown from a horse, at the race track.Look up Fracture in the Index (Volume 3)  Fracture - temporal bone (styloid) -> S02.1 Look at the note on the Tabular List. This indicates that you can add an additional digit to indicate if the fracture is open or closed. A fracture which is not specified as open or closed should be assumed to be closed. The full code is therefore S02.10

56. ANSWERS FOR Ex 5 …To find the correct external cause code refer to the transport accident table in Volume 3. The first column indicates the type of transport the person who was injured was using and the list across the top indicates what they collided with, or how the accident happened. We need to match up the animal drawn vehicle with the non-collision transport accident. This will give us code V80.0. If we refer to volume one we note that the code description includes fall from horse.

57. ANSWERS FOR Ex 5 …You will note that no place of occurrence code is required for this code, but an activity code needs to be assigned. Referring to volume 1, we know that the person was a jockey at the race track. From this would assign a 2 for the activity code. Therefore the complete external cause code is V80.02

58. Answers for Ex 6Late effect of fracture of ulna from tripping over child's toy at home two months previouslyLook up late effect in the Index (Volume 3). You will see a note referring you to see Sequelae (Volume 3).  Sequelae - fracture - - limb - - - upper NEC -> T92.1 To find the external cause code, look up sequelae in the External Cause Index (Volume 3)

59. Answers for Ex 6 … Sequelae - accident NEC -> Y86 We cannot find a more specific code for this accident. No place of occurrence or activity code is required

60. Answers for Ex 7Sprained ankle during recreational football game at park, after colliding with another person. Look up sprain in the Index (Volume 3).  Sprain -ankle -> S93.4 To find the external cause code, look up collision, in the Index (Volume 3).  Collision - person -> W51.- Refer then to volume 1 for the place of occurrence code, which will be .8 for the park.

61. Answers for Ex 7 …The activity code then needs to be assigned, which is .1 for the recreational activity. Therefore the complete external cause code is W51.81 

62. Answers for Ex 8 Accidental perforation of eardrum by knitting needle at home, 2 year old child.Look up perforation in the Index (Volume 3). Perforation -eardrum - see Perforation tympanum  Perforation -tympanum - - traumatic -> S09.2To find the external cause code, look up contact in the Index, (Volume 3).

63. Answers for Ex 8 … Contact - with - - needle -> W27.- Refer then to volume 1 for the place of occurrence code, which would be .0 for the home. The activity code then needs to be assigned, which will be .9 as no activity has been specified at the time of the accident. Therefore the complete external cause code is W27.09 

64. Answers for Ex 9 A 4 year old fractured her fibula after falling from a child's tricycle in the driveway at home Look up fracture in the Index (Volume 3) Fracture -fibula(alone)(styloid) -> S82.4 As we have no further information about the fractured fibula we cannot give a more specific code To find the correct external cause code refer to the transport accident table in Volume 3

65. Answers for Ex 9 …The first column indicates the type of transport the person who was injured was using and the list across the top indicates what they collided with, or how the accident happened. We need to match up the pedal cycle with the non-collision transport accident. This will give us code V18.-If we refer to volume one we note that a fourth digit is required to indicate the person's status in the vehicle and whether it was a traffic accident or not .The correct digit to assign is a 0

66. Answers for Ex 9 …You will note that no place of occurrence code is required for this code, but an activity code needs to be assigned. Referring to volume 1, we know that the person was a child at home, however we do not know what activity they were involved in at the time Therefore assign 9 for the activity code The complete external cause code is V18.09

67. Answers for Ex 1019 year old professional golfer sustained a twisting injury to his left knee on the golf course. Arthroscopy revealed a tear of the medial cartilage.Look up tear in the Index (Volume 3). Tear - cartilage(see also Sprain)  Sprain -knee - - medial collateral S83.4When we refer to the S83 category in the Tabular List (Volume 1) we will note that S83.2 is a more appropriate code to use for this condition

68. Answers for Ex 10 …To find the external cause code, look up twisting in the External Causes Index (Volume 3).  Twisting, excessive -> X50.-Refer then to volume 1 for the place of occurrence code, which would be .3 for the golf course.The activity code then needs to be assigned, which would be 0 or a 2 depending whether the activity is considered to be work related (if the patient is a professional golfer) or a sport activity (if the patient was playing for recreation only)

69. Answers for Ex 10 …Therefore the complete external cause code could be X50.30 or X50.32If both of the activity codes apply, select the lower number i.e. the code higher on the list of activity codes

70. Answers for Ex 11This boy is receiving treatment for the damage to his flexor pollicis muscle as result of the open woundFirstly we need to look up the injury to his muscle, find Injury in the Index (Volume 3). Injury -muscle(and tendon) - - flexor - - - thumb, long(wrist and hand level) -> S66.0If you were only coding one condition the muscle injury would be your main condition. With multiple condition coding, the open wound needs to be coded as well

71. Answer for Ex 11 …Look up Wound in the Index (Vol 3)  Wound, open -thumb -> S61.0To find the external cause code look up contact in the External Causes Index (Volume 3).  Contact - with - - knife -> W26.- Refer then to volume 1 for the place of occurrence code, which is .8 for the pier. The activity code then needs to be assigned, which is .1 for the leisure activity. Therefore the complete external cause code is W26.81

72. Answer for Ex 12Look up fracture in the Index (Vol 3)Fracture-femur- shaft(lower third)(middle third)(upper third) -> S72.3 Refer to Volume 1/Tabular List for S72.3. At the beginning of the S72 category is a note providing fifth character subdivisions for use with this category. They are used to indicated whether a fracture is open or closed. We have been told that the fracture is closed, there we would use the 0. The full code for the fractured femur is S72.30

73. Answer for Ex 12 …As the patient has two fractures, we need to code the other fracture as well. Look up fracture in the Index (Volume 3) Fracture -tibia(shaft)(with fibula) -> S82.2Refer to the Tabular List. At the beginning of the S82 section there is a note providing a 5th character subdivision for use with this section to indicate whether the fracture is open or closed. The fractured tibia is described as a compound fracture, which is an open fracture, therefore we would use a 1. The complete code for the fractured tibia is S82.21

74. Answer for Ex 12 …To find the correct external cause code refer to the transport accident table in Volume 3. The 1st column indicates the type of transport the person who was injured was using and the list across the top indicates what they collided with, or how the accident happened. We need to match up the motorcycle rider with the collision with a car. This will give us code V23.-If we refer to Volume we note that a 4th digit is required to indicate the person's status in the vehicle and whether it was a traffic accident or not.

75. Answer for Ex 12 …The correct digit to assign is a 4. You will note that no place of occurrence code is required for this code, but an activity code needs to be assigned.Although we can refer to volume 1, we do not know what activity the patient was involved in at the time. Assign 9 for the activity code to complete external cause code, V23.49

76. Answer for Ex 13The scar contracture has been identified as a 'late effect' of the wrist wound. We need to code both the scar contracture and the late effect/sequelae to completely describe the patient's condition. Look up scar in the Index (Volume 3) – section 1. Scar -> L90.5Look up Sequelae in the Index (Vol 3) – section 1. We are looking for sequelae of an open wound.

77. Answer for Ex 13 … Sequelae -wound, open - - limb - - - upper -> T92.0 To find the external cause look up sequelae in the Index (Volume 3) – section 3.  Sequelae - suicide(attempt) -> Y87.0 No place of occurrence or activity codes are required

78. Answer for Ex 14 This patient has poisoned herself using Diazepam. For this case we need to use the Table of drugs and chemicals (Section III) of the Index, to find a code for the poisoning. As previously, it is possible to add an external cause code to indicate how the accident occurred. The relevant codes are included in this Table as well. Refer to List (Vol 3) to find the entry for Diazepam. You will note that there are 5 columns of codes in the Table. The columns we need to refer to are firstly, the one for the Chapter 19 code (the 1st column), & secondly, the intentional self-harm column (col 3).

79. Answer for Ex 14 …We look down the table to find Diazepam, and then across to the first column to find T42.4. Then we check the 3rd column for the external cause code X61.-Refer then to volume 1 for the place of occurrence code, which would be .0 indicating home. The activity code then needs to be assigned. As we do not know the activity the patient was involved in a 9 is assigned. Therefore the complete codes are T42.4, X61.09

80. Answer for Ex 15Look up burn in the Index (Volume 3).  Burn - legs - see limb, lower  Burn - limb - - lower -> T24.- Refer to Volume 1 for the 4th character, which will be .2 for our case. The correct code for the leg burns is therefore T24.2.To code the external cause, look up Fire in the Index (Volume 3)

81. Answer for Ex 15 … Fire (see also Exposure fire)  Exposure - fire - - uncontrolled - - - in building or structure -> X00.- Refer to the Tabular list for X00.- which refers the coder to pages 1013-1017 for the appropriate 4th digit to indicate the place of occurrence. We will use .0 to indicate home.

82. Answer for Ex 15 …Then refer to volume 1 for the correct activity code. As no indication is given as to the activity the person was involved in at the time of the house fire, the correct fifth digit would be 9. The final correct code is X00.09