# AAPC Proficiency Assessment Workbook Cases



## allaire_s (Oct 31, 2013)

After reaching out to AAPC, I was given a permission to discuss the workbook cases in the forum. If you have the book, it is the case#49. 
CC: Painful toe with progressing cellulitis.
DX: Acute osteomyelitis.

H/P: This gentleman by history stepped on a nail while working at the construction site some weeks ago and developed a cellulitis infection of the right foot, particularly at the area of the fifth toe. He as placed on IV antibiotics, wound care, and elevation. However, this progressed to abscess and irretrievable ischemia of the right fifth toe. He comes no for amputation of it.

What would you code for diagnoses?

I agree with AAPC using the Osteomyelitis code M86.171, but have a hard time with the sequela injury codes. Per answer key, S91.134S would be added as the cause of the infection. Plus, W45.0xxA would be added for the external cause. 

Two issues: is this a late effect? A nurse practitioner reviewed this note and did not feel that a physician had documented a link between the two, plus added that the osteomyelitis could have been caused by other than the puncture.
Why was the seventh character A used for the external cause code if it is a sequela?

Looking forward to your comments! Thanks!


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## mitchellde (Oct 31, 2013)

Perhaps the wording "and developed a cellulitis infection" is where they are indicating a relationship.  If so I agree with the adding of the injury, however I do not agree with the use of the A on the external cause, It should be an S.
The claim would then say the patient is here with a cellulitis caused by an injury to the foot caused by stepping on a nail.   The A on the external cause does not make sense at all.


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## allaire_s (Oct 31, 2013)

Thank you Debra, it does not make sense to me too! Agree with your answer.


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## jacicj (Nov 1, 2013)

Good questions!  The "A" is appended to the second code (the external cause) because this visit represents active treatment for the sequela.


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## mitchellde (Nov 1, 2013)

No it does not work that way.  the external cause code goes with the injury this is the patient's visit for the sequela from the injury, the injury being originally cause by stepping on the nail.  therefore the infection is a late effect of having stepped on a nail.


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## osbornemcclain@hotmail.com (Apr 10, 2014)

I spend the last two night looking for case studies or //http//cloud.com/document./instructor) and for some unknown reason I can't find it. could someone help us please.


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