# Help with dog bite dx coding, please



## jnewell75 (Aug 1, 2016)

I have a patient who was seen in the ED and diagnosed with a dog bite of the right lower limb.  The ED will use S91.351A as the accident code.  Two days later the patient has presented again and been placed in observation but has now been diagnosed with cellulitis to the area of the bite.  I know that my primary dx code will be L03.115 for the cellulitis but can I still code S91.351A?  Or, should I code it as S91.351S, for sequela since another condition has arisen from the bite?  Technically, we are still treating the current dog bite and it seems like I should use S91.351A, but I wanted another opinion.  Any help would be appreciated.


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## bdette810 (Aug 1, 2016)

*external cause codes*



isabeau_01 said:


> I have a patient who was seen in the ED and diagnosed with a dog bite of the right lower limb.  The ED will use S91.351A as the accident code.  Two days later the patient has presented again and been placed in observation but has now been diagnosed with cellulitis to the area of the bite.  I know that my primary dx code will be L03.115 for the cellulitis but can I still code S91.351A?  Or, should I code it as S91.351S, for sequela since another condition has arisen from the bite?  Technically, we are still treating the current dog bite and it seems like I should use S91.351A, but I wanted another opinion.  Any help would be appreciated.



can you use the cellulitis code and add the external cause codes for dog bite?  W540XXA with the place of occurrence code


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## mitchellde (Aug 1, 2016)

The cellulitis was not caused directly by the dog biting it was a complication of trauma wound. Go to complication and then trauma.  Then you use the 7th character A on the complication code and do not code the original injury code.


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## AlanPechacek (Aug 8, 2016)

The original injury was a Dog Bite of the Right Foot as based on the code S91.351A, which is now complicated by Cellulitis (L03.115), for which the patient has been placed in Observation.  At this point, both the Dog Bite Wound (which has probably not healed yet) and the Cellulitis are under active treatment.  Therefore, I would list as many pertinent codes as can be identified, with the Sequela/Complication (Cellulitis) being listed first, followed by the original injury code with 7th Character now being S, the the External Cause Codes with the W54.XXS (Dog Bite with now a complication/sequela (S)), and whatever Y92, Y93, and Y99 codes can be accurately identified.  The W and Y Codes, as External Cause Codes, are supplementary to the injury and complication codes, and may or may not be required by the patient's insurance.  But, I would list and submit all the codes you can.  Let them sort it out.  That way they can't come back at you for insufficient coding.  Put and keep the ball in their court.  Sooner or later, External Cause Codes are probably going to be required by most payers, if for no other reason than to make your job more difficult.  Learn to do it now rather than later.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com


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