Health Information Management

Coding for the Iceman

HIM-HIPAA Insider, August 11, 2014

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Ötzi the Iceman suffered from atherosclerosis. A pair of hikers discovered Ötzi’s well-preserved mummy in the Ötztal Alps, near the border between Austria and Italy, in 1991. Since then, scientists have performed numerous tests on Ötzi and discovered a wealth of medical information.

In addition to his atherosclerosis, Ötzi also suffered from:
  • Lyme disease
  • Whipworm infestation
  • Tooth decay
He probably suffered a head injury, according to proteins in his brain, before being shot in the shoulder by an arrow and bleeding to death. And because of his advanced (for the time) age of 45, he also suffered from worn joints, which probably caused pain.
 
How would we code Ötzi’s various maladies in ICD-10-CM?
 
For his atherosclerosis, we need to know whether it is a native vessel or a bypass. Since they didn’t do bypass surgery in Ötzi’s day, we’ll go with native vessel. That leaves us with these choices:
  • I25.10, atherosclerotic heart disease of native coronary artery without angina pectoris
  • I25.110, atherosclerotic heart disease of native coronary artery with unstable angina pectoris
  • I25.111, atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
  • I25.118, atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
  • I25.119, atherosclerotic heart disease of native coronary artery with unspecified angina pectoris
We also see a note to use an additional code, if applicable, to identify:
  • coronary atherosclerosis due to calcified coronary lesion (I25.84)
  • coronary atherosclerosis due to lipid rich plaque (I25.83)
The team that uncovered Ötzi’s atherosclerosis noted a buildup of calcium in his arteries, so we’ll need to add I25.84 as a secondary code.
 
On to Ötzi’s Lyme disease. That’s a pretty easy one because we only have one choice: A69.20.
If Ötzi suffered complications due to his Lyme disease, we would use one of these codes instead:
  • A69.21, meningitis due to Lyme disease
  • A69.22, other neurologic disorders in Lyme disease
  • A69.23, arthritis due to Lyme disease
  • A69.29, other conditions associated with Lyme disease
The whipworm infestation is also easy to code. When you look up whipworm in the ICD-10-CM Alphabetic Index, you find an entry for: whipworm (disease)(infection)(infestation) B79.
 
Because we know not to code only from the Alphabetic Index, we look up B79 in the Tabular List, where we find:
B79, Trichuriasis
Includes:
trichocephaliasis
whipworm (disease)(infection)
 
Next up is tooth decay. When we look up decay in the ICD-10-CM Alphabetic Index, we are directed to see Caries, dental. You may have already known that, but if not, the index directs you to the correct entry.
These codes require more information than just dental caries. For example, we need to know what kind of caries Ötzi had:
  • K02.3, arrested dental caries
  • K02.5-, dental caries on pit and fissure surface
  • K02.6-, dental caries on smooth surface
  • K02.7, dental root caries
  • K02.9, dental caries, unspecified
For caries on pit and fissure surfaces and those on smooth surfaces, we also need to know how far the caries penetrated:
  • Limited to enamel (fifth character 1)
  • Penetrating into dentin (fifth character 2)
  • Penetrating into pulp (fifth character 3)
ICD-10-CM does not require you to specify which teeth are involved.
 
What about Ötzi’s fatal injuries—the blow to the head and the arrow wound?
 
Scientists documented that he suffered a craniocerebral trauma with major bleeding in the back of the brain, along with a skull fracture. Unfortunately, they didn’t say exactly what type of fracture.
 
As for the bleeding, Ötzi likely suffered a brain hemorrhage caused by an artery in the brain bursting and causing localized bleeding in the surrounding tissues. You’ll find the codes for traumatic cerebral hemorrhages divided by side of the brain:
  • S06.34-, traumatic hemorrhage of right cerebrum
  • S06.35-, traumatic hemorrhage of left cerebrum
  • S06.36-, traumatic hemorrhage of cerebrum, unspecified
The codes also specify different times for loss of consciousness:
  • without loss of consciousness
  • with loss of consciousness of 30 minutes or less
  • with loss of consciousness of 31 minutes to 59 minutes
  • with loss of consciousness of 1 hours to 5hours 59 minutes
  • with loss of consciousness of 6 hours to 24 hours
  • with loss of consciousness greater than 24 hours with return to pre-existing conscious level
  • with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving
  • with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness
  • with loss of consciousness of any duration with death due to other cause prior to regaining consciousness
  • with loss of consciousness of unspecified duration
Because we don’t know if Ötzi lost consciousness or specifically where the hemorrhage occurred, we can’t assign a code. We would need to query Ötzi’s physician.
 
We’ve now come to Ötzi’s final injury: the arrow in the shoulder. The arrowhead entered the left shoulder blade and came to rest near Ötzi’s lung. Although it did not damage any internal organs, the arrowhead severed an artery and Ötzi bled to death.
 
If we look up laceration, blood vessel in the Alphabetic Index, we are directed to see injury, blood vessel. We find lots of codes for blood vessel injuries. These codes, not surprisingly, identify the location of the blood vessel and, in some cases, the actual blood vessel itself. For example, we can code an injury to the common carotid artery.
 
When we look at blood vessel, shoulder, we’re directed to see:
  • Specified, NEC – see injury, blood vessel, arm, specified site, NEC
  • Superficial vein – see injury, blood vessel, arm, superficial vein
We know we are not dealing with a superficial vein because the physician documented that the arrowhead ended up near the lung. Our most likely code is S45.812A (laceration of other specified blood vessels at shoulder and upper arm level, left arm, initial encounter).
 
And with that, we are at the end of the Iceman’s medical record.
 
This article originally appeared on HCPro’s ICD-10 Trainer blog.



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