Health Information Management

Mardi Gras mayhem

HIM-HIPAA Insider, February 23, 2015

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Ah, Fat Tuesday (AKA Mardi Gras), the last big blowout before Lent begins. For those not of a religious bent, it’s still a good reason for an all-day party.

 
Here at the Fix ‘Em Up Clinic, we have seen quite a few cases of partying gone bad. I’ve lost count of the number of times I have reported T51.0X1A (toxic effect of ethanol, accidental [unintentional], initial encounter), more commonly called alcohol poisoning.
 
You’ll find this code in the familiar looking Table of Drugs and Chemicals, but be sure you go to the Tabular List for the final code. Codes T51-T65 (toxic effects of substances chiefly nonmedicinal as to source) include some important notes.
 
The first involves intent. The ICD-10-CM Table of Chemicals and Drugs clarifies the intent of the poisoning as:
  • Accidental
  • Intentional self-harm
  • Assault
  • Undetermined
When no intent is indicated, code to accidental. You can only report undetermined intent when the provider documents in the record that he or she cannot determine the intent of the toxic effect.
 
These codes also feature a note instructing us to use additional code(s) for all associated manifestations of toxic effects, such as:
  • Respiratory conditions due to external agents (J60-J70)
  • Personal history of foreign body fully removed (Z87.821)
We also find an Excludes1 note that tells us not to code contact with and (suspected) exposure to toxic substances (Z77.-) with codes from T51-T65. Remember, an Excludes1 note means the conditions are mutually exclusive. They can’t be reported together.
 
Not all of our patients ingested too much alcohol, although alcohol may have been a contributing factor in Chrissy’s injury.
 
Chrissy’s company held a Mardi Gras party in the office, which included the distribution of Mardi Gras beads. One of Chrissy’s coworkers decided to twirl those beads and whipped them right into Chrissy’s face. Normally, you would just shrug it off, have some choice words with said coworker, and go about your day.
 
Unfortunately for Chrissy, one of the beads hit her in the eye and now she is suffering from blurry vision and pain in her eye.
 
Dr. Krewe examines Chrissy and diagnoses hyphema. ICD-10-CM divides hyphema into two types in different sections of the ICD-10-CM Manual:
  • Hyphema (H21.0-)
  • Traumatic hyphema (S05.1-)
Dr. Krewe documented that Chrissy’s hyphema was caused by the bead hitting her in the eye, so we would report traumatic hyphema. We need a little more information to select the code.
 
Subcategory S05.1- (contusion of eyeball and orbital tissues) includes traumatic hyphema as a subterm, so we know we’re in the right place. We also see an Excludes2 note for:
  • Black eye NOS (S00.1)
  • Contusion of eyelid and periocular area (S00.1)
This is the second type of Excludes note in ICD-10-CM. Excludes2 means the excluded terms are not part of the code they are listed under, but the patient can have both at the same time. When they do, we’ll report two codes.
 
For example, if Dr. Krewe documented traumatic hyphema and a contusion of the eyelid for Chrissy, we would report both codes.
 
To select the appropriate code, we need to know which eye is involved and the encounter type. S05.1- does not include bilateral as a choice, so if both of Chrissy’s eye are injured, we would report two codes.
 
ICD-10-CM does give you an unspecified code, but I wouldn’t use it. Dr. Krewe really should be documenting the laterality.
 
We also need a seventh character for this code:
  • A, initial encounter
  • D, subsequent encounter
  • S, sequela
If Chrissy was seen for an initial encounter for traumatic hyphema of the right eye, we would report S05.11XA. Don’t forget your placeholder to keep the encounter as the seventh character.
 
Laissez les bons temps rouler.
 
This article originally appeared on HCPro’s ICD-10 Trainer blog.



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