I was driving this past weekend near the lake in my home town and the car in front of me swerved and went left of center because a bird literally flew in to the windshield. Fortunately, there were no other cars traveling in the opposite direction and the driver was quickly able to recover his vehicle. Unfortunately, the little feathered guy didn’t make it. We moved him off the road. As we moved the bird off the road and the guy was babbling on and on, obviously freaked out by what just happened, my mind drifted to whether there was an ICD-10-CM code for “hit by a bird”. I mean, seriously, who wonders about such a thing like ICD-10-CM at a time like this?
I arrived in the office Monday morning, opened my ICD-10-CM coding manual, and you wouldn’t believe what I found. Or if you are a coder or have a lot of experience with birds, maybe you DO believe what I found! LOL
But first, let’s take a little deeper look at an ICD-10-CM coding manual. Essentially, there are two main parts:
- The Alphabetic Index;
- The Tabular List.
Coding guidelines are very specific on how to code and it’s more complicated than just “two main parts” of the manual. For starters, you must start in the Alphabet Index and once you find what you are looking for there, you must look up the code, the Alphabet Index gives, you in the Tabular List. You cannot stop after finding what you need in the Alphabet Index. If you do, you will not always be coding accurately. Always verify in the Tabular List!
Let’s go back to my story above. Had the driver been injured, we would start in the Alphabetic Index, in the section of “External Causes of Injuries”.
- Look up ‘Accident’ →’Driver’→ ‘Collison (with)’→ ‘Animal’→ Nontraffic. That takes me to V40.0. Now it’s off to the Tabular List.
- Take V40.0, that was found in the Alphabetic Index in the External Causes of Injuries tab and find it in the Tabular List. Look up ‘V40.0- Car driver injured in Collison with Pedestrian or Animal in Nontraffic Accident. Here you will find instructions stating that the 7th character for the encounter (initial encounter, subsequent encounter, sequlae) is required. If the 7th character for the encounter is required, but I only have 4 characters right now, V40.0, I have to add two (2) place holders to V40.0” XX” in order to be able to affix my 7th character.
- If this man went to the hospital for his injury, this would be an initial encounter, so the hospital Emergency Department would use the ‘initial encounter’ 7th character of an “A”.
- The final code is V40.0XXA- Car Driver Injured in Collison with Pedestrian or Animal in Nontraffic Accident.
After looking up the above code, my mind wondered to other things like when my cousin was pecked by a chicken and the chicken drew blood and won! So, I looked up “pecked by a chicken” to see if there was such a thing in my ICD-10-CM coding manual. I used the same process as outlined above. The initial language to look for is “struck” and not “peck”. That came later.
Struck by a Chicken:
- Start again in the “External Causes of Injuries” in the Alphabetic Index. External cause Index in the Alphabetic Index→ Contact→ Bird →Chicken→ “See Contact, with chicken” → W61.33 and under the heading is “peck”, W61.33. Now it’s off to the Tabular List.
- Take W61.33 that was found in the Alphabetic Index in the External Causes of Injuries section and find it in the Tabular List. The instructions in the Tabular List says that the 7th character for the encounter (initial encounter, subsequent encounter, sequlae) is required. Since I only have five (5) characters in my current code of W61.33, I will need to add the placeholder “X”, so I can add the 7th character, W61.33”X”.
- Next, determine which of the 7th character for the encounter is appropriate. I selected “subsequent encounter”, or “D”, because I remember my cousin being a little drama queen screaming and crying because she was bleeding everywhere since her skin was punctured after being pecked by a chicken. Therefore, I assumed that if ICD-10-CM was in place in 1978, the pediatrician would have opted to go with the “D”, subsequent encounter 7th character, for the multiple visits to his office following the Emergency Room visit.
- The final code is W61.33XD-struck by chicken, subsequent encounter.
Do you want to try one on your own? How about this one: “Bitten by Macaw”? Have fun with it!!
Director of Compliance and Regulatory Strategy