Radiology Coding Alert

ICD-10-CM:

Snow Doubt About It — Time to Refresh Your Winter Injury Coding Skills

Published on Tue Nov 22, 2022

Remember that 7^thcharacter A stands for active treatment.

From the slopes to the trails, winter has plenty of outdoor activities to enjoy. Unfortunately, some patients may get hurt doing the activities they love, and your coding skill will be needed to report diagnostic imaging tests, injury diagnoses, and activity codes.

Grab a cup of hot cocoa, your code sets, and see if you can correctly code these winter injuries.

Sort Out the Codes for a Sledding Injury

Scenario: An 8-year-old patient presents to the emergency department (ED) with their parents. The family was sledding at a local hill when the child went off a jump and landed awkwardly on their right arm and shoulder. The child is complaining of severe pain in the upper right chest and right forearm. Anteroposterior (AP) and oblique X-rays of the clavicle reveal a nondisplaced fracture of the right clavicle shaft, while AP and lateral X-rays of the forearm reveal a greenstick fracture of the right ulna.

Starting with the CPT^®codes, you’ll assign 73000 (Radiologic examination; clavicle, complete) and 73090 (Radiologic examination; forearm, 2 views) to report the X-rays of the patient’s right clavicle and right forearm. Depending on your individual payer’s preferences, you may also need to append RT (Right side) to each CPT^®code to indicate laterality.

Next, you’ll open your 2023 ICD-10-CM code set to select the correct diagnosis codes. For the scenario presented above, you’ll assign two diagnosis codes:

S42.024A (Nondisplaced fracture of shaft of right clavicle, initial encounter for closed fracture)
S52.211A (Greenstick fracture of shaft of right ulna, initial encounter for closed fracture)

In the Alphabetic Index, there are two sections related to fractures — pathological fractures (caused by the weakening of the bone) and traumatic fractures (caused by outside forces). Since the child suffered the fractures as a result of the crash landing while sledding, you’ll find the correct codes under the Fracture, traumatic section.

When you locate the injuries in the ICD-10-CM Alphabetic Index, you’ll notice that the codes aren’t complete, and additional characters are needed to complete the codes.

In this scenario, the additional characters are used to indicate laterality and the type of encounter:

Laterality: For the codes listed above, the 6th character indicates on which side of the body the injury occurred, if specified in the documentation.
Type of encounter: The 7th character indicates the type of encounter for which the patient is seeking treatment. Both codes listed above feature 7th character “A,” which signifies the patient is in active treatment.

The physician diagnosed the patient with two different fractures — a nondisplaced fracture of the clavicle shaft and a greenstick ulna shaft fracture. You’ll report the fractures by linking S42.024A to CPT^®code 73000 and linking S52.211A to CPT^® code 73090.

Apply external cause codes: Depending on the individual payer preferences, you may need to assign one or multiple external causes of morbidity codes to reflect what the patient was doing at the time of the injuries.

“While there is no national mandate to apply external cause codes, there may be state or insurance payer mandates,” says Lauren E. Braico, CPC, CEDC, medical coder at Practice Resources LLC in Syracuse, New York. External cause codes, such as activity codes, provide information for injury research data and allow researchers to evaluate injury prevention strategies. “Generally, it is encouraged to include external cause codes when the information is documented,” Braico adds.

If required by a payer mandate, you’d assign V00.228A (Other sled accident, initial encounter) and Y93.23 (Activity, snow (alpine) (downhill) skiing, snowboarding, sledding, tobogganing and snow tubing) to indicate the patient was sledding when they were injured.

Don’t Confuse Contusion Dx Coding

Scenario: A 28-year-old patient visits the ED following an accident while riding their snowmobile. The patient hit a bump in the terrain, which caused them to collide with the handlebars. The patient was complaining of sharp pains in the middle of their chest. Lateral and AP X-rays were negative for a fracture. The physician diagnosed the patient with a middle chest bruise.

You’ll assign 71046 (Radiologic examination, chest; 2 views) because the radiologist captured lateral and AP X-ray views of the patient’s chest. Next, you’ll assign S20.214A (Contusion of middle front wall of thorax, initial encounter) to report the bruised chest diagnosis.

This scenario is another example of where you’d assign additional codes to indicate what the patient was doing at the time of the injury, if mandated by the payer. As a reminder, “Reporting an external cause code would only be required on a state-to-state basis or if required by a particular payer,” says Ashley Price, COC, CPC, RCC, medical coder at Change Healthcare in Nashville, Tennessee.

In the scenario above, the patient was riding their snowmobile when the injury occurred. The injury involved a motorized vehicle, but didn’t involve another vehicle, so you’d assign V86.52XA (Driver of snowmobile injured in nontraffic accident, initial encounter).

X marks the spot: When you verify V86.52- (Driver of snowmobile injured in nontraffic accident) in the Tabular List, you’ll notice the code features a 7th character required icon. To complete the code, you’ll add a placeholder character “X” before the 7th character to make the complete code valid.

Similar to the sledding scenario, you may also need to assign Y93.29 (Activity, other involving ice and snow) to the claim depending on if the payer requires an activity code for reporting purposes.