HCPro.com - Coding Educator

Editor’s Note

Mon, 18 Oct 2010 05:00:00 GMT

Beginning soon, Coding Educator will be moving to a blog format. We’ll provide a link to the new blog and instructions for signing up to receive notifications when the blog is updated.

For those of you interested in receiving additional coding updates in your inbox, consider signing up for JustCoding News: Inpatient and JustCoding News: Outpatient; the free companion e-newsletters to Justcoding.com. These bi-monthly e-newsletters contain one free article, a coding trivia question, a mini-poll, links to free discussion boards, an "ask the expert" coding question/answer, a news brief, and several new product alerts.

Alzheimer’s Awareness and Memory Walk

Mon, 18 Oct 2010 05:00:00 GMT

Each October, the Alzheimer’s Association Memory Walk is held to raise awareness and funds for care, support and research for the disease, which currently affects approximately 5.3 million people worldwide.

Alzheimer’s disease is a progressive disorder that destroys brain cells over time, causing a decline in memory and mental capacity.

According to the Alzheimer’s Association, a German physician named Alois Alzheimer first described the disease in 1906 after seeing a patient who had developed problems with memory, speaking, and cognition. As her systems grew worse, she eventually became bedridden, and died later that same year. Following an autopsy, Dr. Alzheimer published the condition in medical literature in 1907 (it was later named after him in 1910). Since then, scientists have learned much about the disease.

Memory loss that disrupts daily life
Challenges in planning or solving problems
Difficulty completing familiar tasks at home, at work or leisure
Confusion with time or place
Trouble understanding visual images and spatial relationships
New problems with words in speaking or writing
Misplacing things and losing the ability to retrace steps
Decreased or poor judgment
Withdrawal from work or social activities
Changes in mood and personality

ICD-9

Use code 331.0 to report Alzheimer’s disease. An additional code should be reported when applicable to identify Alzheimer’s:

With behavorial disturbance 294.11
Without behavorial disturbance 294.10

ICD-10

Report:

G30.0 Alzheimer’s disease with early onset
G30.1 Alzheimer’s disease with late onset
G30.8 Other Alzheimer’s disease
G30.9 Alzheimer’s disease, unspecified
An additional code may be used to identify:
Delirium, if applicable (F05)
Dementia with behavioral disturbance F02.81
Dementia without behavioral disturnbace F02.80

Alzheimer’s is commonly associated with age, but the two are not linked. However, age, along with family history and genetics, are the main risk factors of the disease, according to the Alzheimer’s Association. In addition, there are a number of risk factors, which include:

Head injury. Evidence suggests that there is a strong link between serious head injury and future risk of the disease.
Heart-head connection. Treating factors like high blood pressure, diabetes, and high cholesterol will help to decrease the chances of Alzheimer’s, as some of the strongest evidence links brain health to heart health.
Healthy aging. Staying healthy as you age will protect against the disease. This includes staying in shape and avoiding tobacco and excess alcohol.

Though there are some drug and non-drug treatments that are able to help with some cognitive (memory, language, judgment, attention span, etc.) and behavioral symptoms (the way we feel and act) associated with Alzheimer’s, there is no cure for the disease.

To find a walk, join a team, or sponsor a participant near you, click here: http://www.alz.org/memorywalk/overview.asp?memory=main_navi

Class Act

Mon, 18 Oct 2010 05:00:00 GMT

NAME: Peggy S. Blue, MPH, CPC, CCS-P

HOMETOWN: Wrightsville, PA

INSTRUCTS: Certified Coder Boot Camp®, Certified Coder Boot Camp Online and Medicare Boot Camp® - Physician Services Version

Hot Shot Pop Quiz

Mon, 18 Oct 2010 05:00:00 GMT

Do you know the answer to the question below? If so, submit your name and answer to Associate Editor Jimmy Carroll at jcarroll@hcpro.com. Each correct answer will be entered into a drawing with a chance to win a prize. The winner will be announced in next month's issue.

A physician excised a 5 mm (excised diameter) benign blue nevus from a patient’s right arm and performed a simple closure. What are the correct code(s) for these services?

Beyond The Code

Mon, 18 Oct 2010 05:00:00 GMT

This day in history

October 18, 1867: The United States took possession of Alaska from Russia

Editor’s Note

Mon, 20 Sep 2010 05:00:00 GMT

Beginning soon, Coding Educator will be moving to a blog format. We’ll provide a link to the new blog and instructions for signing up to receive notifications when the blog is updated.

Alcohol and drug addiction recovery month

Mon, 20 Sep 2010 05:00:00 GMT

When an individual is dependent on or abuses alcohol or drugs, it’s defined as a substance use disorder, according to RecoveryMonth.gov. In September, millions of people that were once afflicted with this disorder celebrate the rejuvenation of their lives through recovery and treatment during National Alcohol and Drug Addiction Recovery month.

Millions of Americans are in need of treatment for substance abuse disorders today. RecoveryMonth.gov presents some telling numbers on a few examples of substance abuse.

As of 2006:

125 million people commonly misused alcohol
72.9 million people commonly misused tobacco
14.8 million people commonly misused marijuana
7 million people commonly misused prescription-type drugs
5.2 million people commonly misused pain relievers
2.4 million people commonly misused cocaine

In 2006, only 4 million out of 22.6 million that were in need of treatment actually received some form of treatment, according to RecoveryMonth.gov. In order to improve these numbers, awareness and recognition of abuse disorders must be raised throughout the entire nation.

Not only does the misuse of the aforementioned substances affect an individuals health; it can affect a life in a number of different ways. Substance abuse can lead to financial struggle, marital and relationship problems, domestic violence, child abuse, neglect, increased exposure to crime, and much more.

What is the difference between abuse and dependence? Per AHA’s Coding Clinic fromApril 1991, alcohol abuse represents problem drinking and includes those patients who drink to excess, but have not reached a stage of physical dependency on alcohol. It may include such alcohol-related conditions as temporary mental disturbance, slurred speech, blackouts, difficulty in driving, arguments with family and friends, and difficulty in the work environment. Alcohol abuse is classified to code 305.0X, Alcohol abuse. This code includes simple drunkenness.

Drug dependence (drug addiction) is a chronic mental and physical condition related to the patient's pattern of taking a drug or combination of drugs. It is characterized by behavioral and physiological responses. These include a compulsion to take the drug, to experience its psychic effects, or to avoid the discomfort of its absence. There is increased tolerance and an inability to stop the use of the drug even with strong incentives. Such patients often experience physical signs of withdrawal when there is any sudden cessation of drug taking.

Coding Clinics address different issues in regards to the treatment of substance abuse/dependency. Patients who are opioid dependent are often treated with Methadone. When a physician documents “methadone use” as a treatment for opioid dependence, code 304.01(methadone dependence) should be assigned. Coding Clinic, October 1995>

Detoxification is defined as the active management of withdrawal symptoms in a patient who is physically dependent on alcohol or drugs. It is more than simple observation while waiting for the patient to recover from inebriation and involves active management. Treatment may involve evaluation, observation, and monitoring, as well as administration of thiamine and multivitamins for nutrition and other medications as needed. Detoxification is usually continued over a 4-5 day period (longer for opiate based drugs) < AHA Coding Clinic, April 1991>

Rehabilitation is defined as a structured program with the goal of establishing strict control of drinking or drug use and to replace this with nonchemical activities. < AHA Coding Clinic, April 1991> Rehabilitation therapy is coded for a patient who begins the program, even if the patient leaves the program before its completion. < AHA Coding Clinic, April 1991>. For patients admitted to a rehabilitation program for alcoholism or drug abuse, code first the alcohol dependence (303), alcohol abuse (305), drug dependence (304), or drug abuse (305) being addressed in the treatment program and assign an additional code of V57.89 for rehabilitation care. Code also any detoxification carried out (94.xx) Coding Clinic, January 1987>

A fifth-digit subclassification is provided for categories 303-305 to indicate the patient's pattern of use:

-0: unspecified

-1: continuous: Alcohol: refers to daily intake of large amounts of alcohol or regular heavy drinking on weekends or days off from work

-2: episodic: Alcohol: refers to alcoholic binges lasting weeks or months, followed by long periods of sobriety

-3: remission: Refers to either a complete cessation of alcohol or drug intake or to the period during which a decrease toward cessation is taking place

How do you report for an overdose in a substance abusing/dependent patient? Based on chapter specific guidelines, assign the poisoning code as the principal diagnosis, then assign the code(s) for the condition(s) as a response to the overdose (e.g. nausea, headache etc). The codes to represent the substance abuse/dependence are 303.xx, 304.xx, 305.xx, but only if documented. If there is also a diagnosis of drug abuse or dependence to the substance, the abuse or dependence is coded as an additional code.

Note that there is an exception to the rule: Acute alcohol intoxication, not “ accidental” or “ suicidal” in nature, is not classified in the poisoning section, but rather in the alcohol dependence or abuse categories when referring to drunkenness or to conditions arising due to heavy alcohol intake over a period of time.

The 2011 ICD-9-CM coding changes identified changes to poisoning code 970, Poisoning by central nervous system stimulants. 970.8 now requires a fifth digit to identify the type of CNS stimulant:

-1 Poisoning by cocaine

-9 Poisoning by other specified central nervous system stimulant.

How do you code for a patient who suffers from documented alcohol or drug “withdrawal”? Once a patient experiences withdrawal, whether prior to or after admission, the treatment protocol changes and the patient is no longer just a “rehab” or “detox” patient. Therefore, a code for the withdrawal should be sequenced as the principal diagnosis to identify this change in protocol.

While the statistics on alcohol and drug addiction will never be perfect; they can always be improved. Raising awareness and exposing the data on these diseases can help encourage those with the disorders to seek help, better themselves, and reclaim their lives. This September, join those in need or in recovery in celebrating national alcohol and drug addiction recovery month.

For more resources and organizations that can help provide treatment, visit the Recovery Month Web site at http://www.recoverymonth.gov. Information on treatment options in your area and the special services available can be found at http://www.findtreatment.samhsa.gov, a searchable database of more than 11,000 U.S. treatment facilities. For additional Recovery Month materials, visit http://www.recoverymonth.gov or call 1-800-662-HELP.

Class Act

Mon, 20 Sep 2010 05:00:00 GMT

NAME: Jennifer Avery, CCS, CPC-H, CPC, CPC-I

HOMETOWN: Niles, MI

INSTRUCTS: Certified Coder Boot Camp®, Certified Coder Boot Camp® Online and Certified Coder Boot Camp® - Inpatient Version

WHAT IS ONE JOB YOU’D LOVE TO HAVE OUTSIDE OF YOUR PROFESSION: I’ve always wanted to be a wedding planner/party planner

ARE YOU A PET OWNER?: Growing up I was always a cat person, but since being married I now have two dogs: a labradoodle and a miniature dachshund.

FAVORITE SEASON OF THE YEAR: It is hard for me to pick one season, I love them all. Each season has its ups and downs just like everything in life. I love the colors of fall, I love the snow-frosted trees in winter, I love the smell of spring and I love the sun in summer.

Hot Shot Pop Quiz

Mon, 20 Sep 2010 05:00:00 GMT

Question: A patient with scoliosis was scheduled for major surgery to repair the shape of his spine. The physician determined that 10 vertebral segments required surgical repair. She performs posterior arthrodesis followed by posterior segmental instrumentation. How should these services be performed?

The winner from August was Pamela Kay Bates, RHIT, HIM department coding specialist at St. Mary’s of Michigan. Pamela won an HCPro 2010 ICD-9 Coding Manual. The correct answer to the question: “A physician performs an open transluminal balloon angioplasty of both the left and right iliac artery. How should this service be performed, is 35454-50.

Beyond The Code

Mon, 20 Sep 2010 05:00:00 GMT

This day in history

September 20, 1891 – The first gasoline-powered car debuts in Springfield, MA.

Cataract Awareness Month

Mon, 16 Aug 2010 05:00:00 GMT

Though cataracts may not be in the forefront of your mind as your read this now, it is important to be aware of them, as nearly everyone that lives into their 70s and beyond will develop cataracts, according to the American Academy of Ophthalmology (AAO).

Cataracts are clouding of the eye’s naturally clear lens, and can cause your eye to become like a window that is frosted or yellowed, according to the AAO. There are a number of misconceptions about cataracts, which include the assumption that cataracts are a growth or film over the eye; a cause of irreversible blindness; a result of overusing the eyes or a contagious disease spread from eye to eye. Though cataracts can cause vision loss, they are treatable; which is why identifying early warning signs is so crucial.

There are number of ways to reduce risk of cataracts, which include using UV-rated sunglasses when outdoors; wearing a wide-brimmed hat; quitting smoking; and minimizing your eye’s direct exposure to the sun. In addition, people with diabetes can reduce cataract risk by diet, exercise, and medications if necessary, according to the AAO.

As we age however, cataracts can develop gradually despite taking these precautionary measures. According to the AAO, the following items are symptoms of cataracts:

Painless clouded, blurry or dim vision
Increasing difficulty seeing at night or in low light>
Sensitivity to light and glare, seeing halos around lights
Colors seem faded or yellowed
The need for brighter light for reading and other activities
Frequent changes in eyeglass or contact lens prescription
Double vision within one eye

If any of these symptoms persist, contacting an eye specialist should be the next step. One positive factor regarding early detection and treatment is that cataract surgery has a high success rate, and is very common. The decision to get cataract surgery is up to the individual. If the symptoms aren’t impairing day-to-day activities, a person may not choose to get surgery.

Keep in mind, however, that cataracts are a leading cause of blindness. With that said, let’s take a look at some common cataract coding procedures and diagnoses that may accompany them:

Extracapsular extraction – removing the lens in pieces

CPT code 66982 – Extracapsular cataract extraction, complex, with insertion of intraocular lens prosthesis

CPT code 66984 -- Extracapsular cataract extraction, routine ,with insertion of intraocular lens prosthesis

Intracapsular extraction – removing the lens in one piece

CPT code 66983 – Intracapsular extraction, with insertion of intraocular lens prosthesis

Diagnosis coding for cataracts will be dependent upon the type of cataract (congenital versus acquired) as well as cataracts due to underlying conditions or causes such as diabetes mellitus or radiation.

Congenital cataracts – 743.3x
Acquired cataracts – 366.xx
- Diabetic cataracts – 366.41 (don’t forget to assign 249.5x or 250.5x first)
- Cataracts associated with radiation and other physical influences – 366.46 (use additional E-code to identify cause)

Editor's Note

Mon, 16 Aug 2010 05:00:00 GMT

Beginning in October, the Coding Educator will move to blog format. As a result, the September 2010 issue of Coding Educator will be the final e-mail edition. In that edition, we’ll provide a link to the new blog and instructions for signing up to receive notifications when the blog is updated.

Class Act

Mon, 16 Aug 2010 05:00:00 GMT

NAME: Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CCDS

HOMETOWN: Richmond (Chesterfield), VA

INSTRUCTS: Certified Coder Boot Camp, Certified Coder Boot Camp – Online Version, Certified Coder Boot Camp – Inpatient Version and the Evaluation and Management Boot Camp, and ICD-10 Basics Boot Camp

IN ONE SENTENCE, EXPLAIN YOUR JOB TO A CHILD: I help people who work in doctor’s offices and hospitals to bill correctly for payment.

LAST SONG PLAYED ON YOUR iPOD: I think it was Into the Mystic by Van Morrison. Great song for relaxing by the pool yesterday.

BEST VACATION YOU’VE EVER TAKEN: Caribbean cruise in February 2010. We got to see lots of great sites (Belize, Costa Maya, Cozumel) all in one trip! Can’t wait to go on another one.

Hot Shot Pop Quiz

Mon, 16 Aug 2010 05:00:00 GMT

A physician performs an open transluminal balloon angioplasty of both the left and right iliac artery. How should this service be performed?

Hot Shot Pop Quiz

The winner from July was Denise Reese, coder at Forrest General Hospital in Hattiesburg, MS. Denise won an HCPro 2010 ICD-9 Coding Manual. The correct answer to the question: “A driver suffered a closed LeFort fracture in a motor vehicle accident striking a guardrail on a highway. The patient presents for a midface reconstruction. The physician uses a LeFort III technique involving a complete separation of the midfacial bones, requiring bone grafts. The procedure is performed without LeFort I. How should this be reported, is 802.4, E815.0, E849.5, 21154.

Beyond The Code

Mon, 16 Aug 2010 05:00:00 GMT

This day in history

August 16, 1977: Elvis Presley died at Graceland, his Memphis home, from heart failure at age 42.

Class Act

Mon, 19 Jul 2010 05:00:00 GMT

NAME: Peggy S. Blue, MPH, CPC, CCS-P

HOMETOWN: Wrightsville, PA

INSTRUCTS: Certified Coder Boot Camp®, Certified Coder Boot Camp Online and Medicare Boot Camp® - Physician Services Version

WHAT WILL BE THE HARDEST PART ABOUT ICD-10: The initial implementation. After that, it will be a piece of cake.

FAVORITE BEACH TO VISIT: Indiana Beach (yes, they have one)

FAVORITE CONCERT YOU’VE EVER ATTENDED: Bruce Springsteen at Purdue University

Hot Shot Pop Quiz

Mon, 19 Jul 2010 05:00:00 GMT

Hot Shot Pop Quiz

Q: A driver suffered a closed LeFort fracture in a motor vehicle accident striking a guardrail on a highway. The patient presents for a midface reconstruction. The physician uses a LeFort III technique involving a complete separation of the midfacial bones, requiring bone grafts. The procedure is performed without LeFort I. How should this be reported?

A: 802.4, E815.0, E849.5, 21155.

B: 802.4, E815.0, E849.5, 21154.

C: 802.4, E816.0, E849.5, 21141.

D: 802.5, E829.8, E849.5, 21150.

The winner from June was Donna Carr, CCS-P, CPC, CPC-H, CPC-P, coding specialist at St. John’s Clinic – Joplin in Missouri. Donna won an HCPro 2010 ICD-9 Coding Manual. The correct answer to the question “A single physician performed posterior arthrodesis of L3-L5 utilizing morselized autograft harvested through a separate fascial incision and posterior segmental instrumentation. How should the physician’s services be reported?” is 22612, 22614, 20937, 22842.

Beyond The Code

Mon, 19 Jul 2010 05:00:00 GMT

This day in history

July 19, 1848: The first women's rights convention, called by Elizabeth Cady Stanton and Lucretia C. Mott, was held in Seneca Falls, New York.

July is UV Safety Month

Mon, 19 Jul 2010 05:00:00 GMT

With exceedingly hot weather comes increasingly dangerous ultraviolet (UV) rays cast off from the unforgiving sun. This July, as the country observes UV safety month, take into consideration the repercussions of prolonged exposure to sunlight.

While enjoying the outdoors is a favorite summertime activity, ultraviolet radiation from too much sunlight is dangerous and can cause adverse eye damage, which can lead to more serious implications down the road. Virtually everyone is vulnerable under the sun, so taking precautionary measures and remaining vigilant will go a long way.

When it comes to protection, the American Academy of Ophthalmic Executives offers some tips for protecting yourself, and ultimately preventing blindness; the worst case scenario for extended and repetitive exposure to UV rays. The tips are as follows:

Wear sunglasses and wide-brimmed hats. Wear sunglasses that block 99 to 100% of UV-A and UV-B rays. (UVA rays are long- wave solar rays of 320-400 nanometers and UVB rays are short-wave solar rays of 290-320 nanometers. UVB are more potent than UVA in producing sunburns.) If you spend time on the water or in the snow, consider purchasing goggles or sunglasses that wrap around the head. Remember to wear these whenever you are outside, even on a cloudy day, when the sun’s rays can still burn through the haze.
Don’t forget the kids. Keep the kids out of the sun during the most intense parts of the day, and always remember to keep them in hats and sunglasses as well.
Be wary of the sun during its peak hours. The sun’s UV rays are most strong between 10:00 a.m. and 2:00 p.m., but you need to protect your eyes whenever you’re outside for a prolonged period of time, despite the level of sunlight.
Keep reflections in mind. Sunlight that is reflected off water, snow and pavement can be the most dangerous type of UV light, because it is intensified.
Protect your eyes at all times. Your eyes can be harmed by sources other than the sun, such as welding lamps and tanning lights, so remember to protect your eyes when using any type of high energy UV rays.

Blindness is the absence of sight. Definitions of blindness may vary in different settings. The term may indicate a total loss of vision or may be applied in a modified manner to describe certain visual limitations, as in yellow color blindness (tritanopia, diagnosis code 368.53) or word blindness (dyslexia – 784.61). Having a blind spot refers to a normal gap in the visual field occurring when an image is focused on the space in the retina occupied by the optic disc. An abnormal gap in the visual field may be caused by a lesion on the retina or in the optic pathways or resulting from hemorrhage or choroiditis, which is often perceived as light spots or flashes.

Main terms in the alpha index to consider when trying to code for these types of clinical situations with the eyes are impairment, vision; or disturbance, vision; or blindness. Volume 1 of the ICD-9 book provides a table defining the different level of impairment based on recommendations from the World Health Organization Study Group on the prevention of blindness.

Another thing to remember is to wear swimming goggles whenever you are in the water, as chlorine from pools and bacteria from ponds and lakes may lead to inflammation. Also consider the fact that sunglasses do not need to be expensive or attractive in order to get the job done; as long as they can block the UV light; they offer protection. Overall, just remain on your guard when it comes to UV exposure, and if you experience any vision problems, consult an eye health professional.

To read more on UV safety month, visit the American Academy of Ophthalmic Executives website.

Fireworks Safety Month

Mon, 21 Jun 2010 05:00:00 GMT

During the months of June and July, Americans nationwide are encouraged to observe fireworks safety. While fireworks can be a cheerful reminder of warm, summertime weather and fun times spent with family and friends outdoors; the fact remains that they are still extremely dangerous and should be used with caution and responsibility.

In 2008, the U.S. Consumer Product Safety Commission reported seven fireworks-related deaths. Two people were killed by aerial and display fireworks, one person died in a fire ignited by a fireworks, three people were killed in incidents involving homemade fireworks, and one person, who was on oxygen, died as a result of a firecracker exploding near his face. In addition, fireworks were involved in nearly 7,000 injuries that were treated in U.S. hospital emergency rooms during the year.

Although these injuries and deaths were preventable and resulted from irresponsible use of fireworks, one positive thing to note is that all of these numbers were down from 2007. CPSC staff reported 11 fireworks-related deaths and 9,800 fireworks-related injuries throughout the year. In order for these numbers to continue to decrease, folks that live in fireworks-legal states must keep in mind a number of safety tips and precautionary measures.

The National Council on Fireworks Safety suggests that if you are going to use fireworks that you should:

Use fireworks outdoors only.
Obey local laws.
Always have water handy.
Use only as intended; don’t try to alter or combine them.
Never relight a “dud” firework. Wait 20 minutes and then soak it in water.
Keep a safe distance from the shooter and wear safety glasses when lighting.
Do not mix fireworks and alcohol. Have a “designated shooter.”
Only person over the age of 12 should be allowed to handle sparklers.
Do not ever use or attempt to make homemade fireworks.
Report illegal explosives to the fire or police department in your community.

Because accidents and injuries occur with use of fireworks this is a good time to talk about burn coding guidelines. Code each three-digit category burn site separately. For example, if there are burns on the trunk, face, and leg, assign codes from category 942, 941, and 945. Assign codes of the same local site, but of different degrees to the subcategory identifying the highest degree recorded in the diagnosis.

If you have second- and third-degree burns on the leg, then the fourth digit assignment should reflect the third-degree burn (945.3x). When sequencing burns, the code that reflects the highest degree burn should be reported first. If you have deep third-degree burns on the back and second-degree burns on the face, report the third-degree burns on the back first.

Assign codes from the 948 category as an additional code to identify the extent of the burns, especially when there is 20% or more of the body burned. To assign 948 category code, you need to be able to dissect what each part identifies. The three-digit 948 reflects burns by extent (percentage) of body surface burned. The fourth digit reflects the total body surface area (TBSA), regardless of degree, burned. The fifth digit reflects the total body surface area (TBSSA) with third-degree burn. For example, if the patient has 38% of the body burned, 20% of the body has third-degree burns the appropriate code assignment would be 948.32.

E-code assignment has gotten a little more interesting with the new codes that were added for 2010 to identify the activity and the activity status for the “how” and “where” we already report with accidents and injuries. Not everything will get the additional E codes, but if there is activity and activity status that fit the scenario, they should be reported.

Here are a few coding scenarios that come to mind when thinking about what can happen with fireworks:

Patient presented with second- and third-degree burns on his right hand, wrist and forearm. He had been shooting off fireworks by his lake home with his friends and family when he was burned by the explosion of a bottle rocket. How should this be coded?

Answer: 943.31, 944.38, E923.0, E849.0, E000.8

27-year-old male presented with deep third degree burns to the face, neck and chest which he received while setting off fireworks at the annual Memorial Day celebration. He is working as a volunteer for the celebration. How should this be coded?

Answer: 941.49, 942.42, E923.0, E849.8, E000.8