Health Information Management

'Tis the season to wash your hands

Coding Educator, December 1, 2008

By Joe Rivet, CPC, CCS-P, CICA

December is national hand washing month. It does seem like there is a season for everything, but this is one that should never go away. Hand washing is the most effective way to prevent the spread of disease and this simple act is rarely done as often as is should be.

It can be challenging to get children (and adults!) to wash their hands. People often give their hands a visual assessment; if they see no dirt, then they considered their hands clean. But if you were to hold a magnifying glass to your hand, it would look like a sponge. Bacteria and germs hang out on your hands without you seeing them. And they often hide in the creases in your hand, and under your nails.

Your front line of defense

From the time people wake up to the time they go to bed, people touch hundreds of items. This includes shaking the hands of other people who may not have washed their hands either.

Let’s say you sneeze, blow your nose, or pet your dog. Of course, you come into contact with germs through each of these acts. But it is very easy for germs to end up on your hands through ways you might not consider. For instance, if you decide to watch a movie with popcorn at the end of a day and you eat the popcorn without washing your hands, it is every easy for germs you’ve picked up throughout the day to enter your body.

Driving home for the holidays? A rental car may look clean and smells new, but remember several other people have touched the steering wheel, blinker switch, radio knob, door handle, and car keys.

Using a hotel pen in your room to write down a note, using a public phone, pushing open a door to a department store, or grabbing a cart at the supermarket are all great ways to have germ-filled hands. People are constantly touch things throughout the day and each time they touch something more germs come along for the free ride.

The American Society of Microbiology surveyed hand washing in 2005 and estimated that one out of five people don’t wash their hands after using the restroom. Think of the hundreds of other people that didn’t wash their hands and then use the same door knob as they left the restroom. Consider the number of germs you will introduce to your body if you use the restroom but neglect to wash your hands before you return to your table at a restaurant to share chips and salsa with your friends.

How to Wash Your Hands

Just squirting a drop of soap on your hands with a quick splash of water will not get rid of those germs hiding out in the nooks and crannies of your hand. For proper hand washing you should:

  • Use warm water. The water should not be cold, but neither does it need to be scalding hot.
  • Use soap of your preference.
  • Wash your hands vigorously and scrub all surfaces of your hand including the back of your hands, between your fingers, under your nails, and beneath any rings you may wear.
  • Wash for at least 15 seconds.
  • Rinse your hands under warm running water and dry with a clean towel.
  • If you are using a public restroom, consider using a paper towel to open and close doors, or flush the toilet. And use a clean paper towel to turn off the water and open the door on your way out so you don’t pick up germs on your clean hands.
Germs are everywhere. But frequent, effective hand washing can go along way to prevent getting yourself (and others) sick.


Coding for common winter sicknesses

Because your patients probably don’t wash their hands enough, you may find yourself reporting ICD-9-CM code 487.1 (influenza with respiratory manifestations other than pneumonia) quite frequently this time of year. You may also often need to report code 487.8 for cases of stomach flu.

Along with simple hand washing, we can protect against germs and diseases with vaccinations. Common vaccines given this time of year include:

  • Influenza vaccine (CPT codes 90655-90663). Code this vaccine based on age, split vs.  live virus, age and route given).
  • Pneuomonia vaccine. Report CPT code 90669 for conjugate vaccine intramuscular administered on children younger than five years of age. Use CPT code 90732 for polysaccharide vaccine adult or immunosuppressed patient dosage, two years of age or older, subcutaneous or intramuscular use.

And don't forget to code for the administration of the vaccine.

By working together to keep our hands clean and getting vaccinations when appropriate, hopefully we can minimize the use codes of ICD-9-CM category 487 codes this winter.

Editor's note: Joe Rivet, CPC, CCS-P, CICA, is a regulatory specialist for HCPro, Inc., in Livonia, MI. You can e-mail him at

Most Popular