Health Information Management

Watch your toes

HIM-HIPAA Insider, July 14, 2014

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Holly spent the weekend hanging out at the beach, enjoying the sun. The sand was so warm that she slipped off her shoes to stroll near the water. And disturbed a crab in the process. The crustacean, unhappy at being disturbed, clamped down on Holly’s right big toe, partially severing it and sending Holly to the Stitch ‘Em Up Hospital.
 
Let’s start with the diagnosis.
 
ICD-10-CM includes codes for complete and partial traumatic amputations. In Holly’s case, the crab didn’t take off the whole toe, so it is a partial amputation. ICD-10-CM further divides toe amputations into the great toe, lesser toes, and more than one toe. And of course we have laterality.
 
Since this is Holly’s first visit for a traumatic partial amputation of the right great toe, we would report S98.121A.
 
Holly needs surgery to reattach her toe, so Dr. Shelley is preparing to put Holly back together, and we can build our ICD-10-PCS code at the same time.
 
First, we know we are in the Medical and Surgical section, which gives us a first character 0 (the number zero, not a capital O).
 
Our second character is the body system. In this case, we’re going with lower extremities, Y.
 
The third character is the root operation. Basically what is the surgeon trying to do? Dr. Shelley is putting Holly’s toe back where it belongs, which makes our root operation Reattachment (N).
 
Note that Reattachment is the root operation of choice whether the surgeon is putting all or a portion of a separated body part to its normal location or another suitable location.
 
We now have the first three characters of our code, 0YM, so we can go to the ICD-10-PCS table.
The table contains plenty of fourth character options for the body part. We know Dr. Shelley is reattaching Holly’s right great toe, so our fourth character is P (first toe, right). If Dr. Shelley reattached multiple toes, we would code each one separately because each has its own body part.
 
The rest of the code is a breeze because we only have one choice for each remaining character:
  • 0, open
  • Z, no device
  • Z, no qualifier
That gives us a final code of 0YMP0ZZ.
 
Holly did get the last laugh on her crustacean attacker. She ate the attacking crab for dinner.
This article originally appeared on HCPro’s ICD-10 Trainer blog.



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