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Whodunit ICD-10 Style
Do you remember the game called Clue? Do you remember Miss Scarlet and Professor Plum, or perhaps the rope and the wrench, or the Dining room or the Library? It was a game of figuring out who committed the crime, where they did it and with what.
The same concepts apply to Chapter 20: External Causes of Morbidity found in ICD-10. "External cause codes are intended to provide data for injury research and evaluation of injury prevention strategies. These codes capture how the injury or health condition happened (cause), the intent (unintentional or accidental; or intentional, such as suicide or assault), the place where the event occurred the activity of the patient at the time of the event, and the person's status (e.g., civilian, military)."
We have similar codes in ICD-9 found in Chapter 19: Supplemental Classification of External Causes of Injury and Poisoning. They are commonly known as the "E codes" and are considered supplemental. "E codes capture how the injury, poisoning, or adverse effect happened (cause), the intent (unintentional or accidental; or intentional, such as suicide or assault), the person's status (e.g. civilian, military), the associated activity and the place where the event occurred." The sometimes-hilarious specificity of some of the new ICD-10 external codes has made them infamous. The increased granularity of documentation has been the butt of many a joke. For example, the code V91.07XA, burn due to water-skis on fire, initial encounter; or code W6133XA, being pecked by chicken, initial encounter; or code W5531XA, being bitten by other hoof stock, initial encounter.
While some of these codes seem far-fetched and can bring humor to coding (which is hard to do), the take away point is to document as specifically possible where little Johnny fell while playing basketball. Was it at his private middle school, the public park, or the neighbor's driveway? Remember, when obtaining the history of present illness (HPI), document whether the accident/injury was accidental, the place it occurred, and what the patient was doing when it happened.
IN THE NEWS
AAPC, WEDI, and CMS Collaborate on ICD-10 Implementation Success Initiative
AAPC, along with the Workgroup for Electronic Data Interchange (WEDI) and the Centers for Medicare & Medicaid Services (CMS) have formed the ICD-10 Implementation Success Initiative.
This initiative is comprised of several different elements, including a public, searchable database of ICD-10 issues for submission, help in determining priority of those issues, and a series of educational webinars and articles available as a resource to highlight prominent ICD-10 conversion issues and trends. The searchable database allows someone to submit an issue, which is then reviewed and made available online.
Understanding how the new codes and coding standards will impact diagnosis and inpatient procedures is imperative to the transition to ICD-10. Be sure to check this new tool out.
CC: Mike presents today after suffering an injury when he fell in the shower. He was in his apartment this morning, taking a shower and dropped the soap. When he went to pick it up he slipped and fell.
Exam: Patient is in mild distress due to pain. He is holding a towel to the back of his head. When the towel is removed, a laceration to the back of his head is seen where he struck the shower door. It is a 4 cm long laceration that is full-thickness.
Assessment/Plan: Laceration to the scalp. Intermediate repair performed after local anesthetic and proper wait time. Patient give instructions on wound care and will return to the office in 2 weeks, sooner if needed.
S01.01XA Laceration without foreign body of scalp, initial encounter
W01.198A Fall on same level from slipping, tripping and stumbling with subsequent striking against other object
Y92.031 Bathroom in apartment as the place of occurrence of the external cause
Y93.E1 Activity, personal bathing and showering
Y99.8 Other external cause status
Rationale: In this scenario, the patient is presenting for active treatment of his new injury suffered after falling in the shower. The first code(s) should be the injury(ies), followed by the external cause codes. According to the guidelines for chapter 20, External Causes of Morbidity, the external cause of the injury (in this case, the fall) code should follow the patient throughout treatment for the injury. The codes for the place of occurrence, the activity, and the external status need only be reported the first time the patient presents. When the patient presents for subsequent treatment, only the injury code and the external cause of the injury code need to be reported.
ICD-10 IMPLEMENTATION STRATEGIES
We will be sharing a number of strategies to help your practice successfully implement ICD-10-CM. Please remember to track your progress in your ICD-10 Implementation Tracker on AAPC's website.
Clinical Documentation Improvement
Continuous assessments of your physician and other providers' clinical documentation should be on your radar. Documentation must meet the higher granularity of ICD-10-CM, and most providers need more than one sit down to help them get there. Start with their main diagnoses and work your way down, one by one. Gather providers of the same specialty for group sessions on specialty-specific topics, offer them articles on issues that pertain to their specialty, make them their own "top 10 list" converted to ICD-10-CM, etc. Whatever will keep them looking at their documentation and what the expectations are for the new code set will help them keep it front and center in their minds. The more they hear it and see it, the more standardized it will become to them.
Want to see what articles on ICD-10 AAPC experts have participated in lately? Check out the most recent articles page. This link will show portions of longer articles that you can click on to see the entire story. It is a good way to keep up to date on the information for ICD-10 transition in one place.