Health Information Management

Jumping for joy?

HIM-HIPAA Insider, December 22, 2014

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On the 10th day of Christmas my true love gave to me 10 lords a-leaping. My house isn’t big enough for all of these dancers.

Several of them mistimed their leaps and collided midair and they’re down in a heap with assorted injuries.
Lord Jim twisted his left ankle. Which ligament? ICD-10-CM subcategory S93.4- (sprain of ankle) includes options for:
  • Calcaneofibular ligament
  • Deltoid ligament
  • Tibiofibular ligament
  • Other ligament (specifically the internal collateral and talofibular)
Lord Byron dislocated his right wrist. Is this the first time he’s dislocated his wrist or is it a recurrent injury? ICD-10-CM includes a separate code subcategory for recurrent wrist dislocations.
The Alphabetic Index is a little annoying, though, when it comes to wrist dislocations. Instead of giving you codes to choose from, it lists the different bones and joints and directs you to see Dislocation, metacarpal (bone), proximal end or Dislocation, carpometacarpal (joint).
Regardless of the bone or joint, we’re going to end up in the S63.0- (subluxation and dislocation of wrist and hand joints) subcategory of codes. Don’t be tempted to just skip ahead to the Tabular List and look for the best code. You can’t code shop in the Tabular List no matter how tempting it might be.
Our final fallen lord, Alfred, pulled a hamstring. Sprain or strain?
A sprain involving stretching or tearing a ligament (tissue that connects bone to bone) or a joint capsule. Not a hamstring then.
Strains involve stretching or tearing of a musculo-tendinous (muscle and tendon) structure. That sounds like a hamstring.
In the ICD-10-CM Alphabetic Index, under Strain, muscle, it tells us to see Injury, muscle, by site, strain.
Here’s where you need to know your leg muscle anatomy. Under Injury, muscle, leg, we do not have codes for a strain of the hamstring. Instead, the index lists:
  • Anterior muscle group
  • Peroneal muscle group
  • Posterior muscle group
The hamstring is a group of muscles located on the back of your thigh, which most coders probably know. It is comprised of four muscles:
  • Biceps femoris
  • Semimembranosus
  • Semitendinosus
  • Adductor magnus (at least part of it)
The quadriceps (a group of four muscles on the front of your thigh) have their own code.
Coders also need to know these other thigh muscles:
  • Adductor brevis muscle
  • Adductor longus muscle
  • Adductor minimus muscle
  • Gracilis muscle
  • Pectineus muscle
  • Sartorius muscle
  • Tensor fasciae latae muscle
If you code for orthopedic injuries, you need to know where each of these muscles is located. Otherwise you won’t know to code Alfred’s hamstring strain using either:
  • S76.311-, strain of muscle, fascia and tendon of the posterior muscle group at thigh level, right thigh
  • S76.312-, strain of muscle, fascia and tendon of the posterior muscle group at thigh level, left thigh
Each code requires a seventh character for the encounter.
Be careful with the muscles. ICD-10-CM does include codes for some specific muscles of the thigh, such as:
  • Adductor (but no more specificity than that)
  • Quadriceps
The rest fall into general groups.
Fortunately all of our lords survived the mash up without breaking any bones. Maybe we can pair them off with the ladies and have a ball. Now we just need musicians.
This article originally appeared on HCPro’s ICD-10 Trainer blog.

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