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Coding Chapter 5
Chapter 17: Injury and Poisoning (800-999)
| Question | Answer |
|---|---|
| When coding multiple injuries, assign separate codes for each injury unless a specific combination code is provided. | True |
| List the _____ _____ serious injury first as determined by the physician | Most Serious |
| When coding a severe injury would you also code an abrasion or contusion in the same area? | No, do not code the superficial injuries associated with more severe injuries at the same site. |
| If a primary injury results in minor damage to peripheral nerves or blood vessels what would you code? | The primary injury is sequenced first with additional codes from categories 950-957 Injury to nerves and spinal cord and/or 900-904 Injury to blood vessels sequence secondarily. |
| How is the cause of the injury identified? | An E code is in addition to primary and secondary diagnoses. |
| What information does an E code provide to the claim? | The E code is important for establishing the circumstances of the injury. Example: Auto claim or workman's compensation. |
| How would you code an open wound? | An open wound is coded by site and complexity. E codes are used to identify the cause of the wound. |
| How would you code a fracture not indicated as open or closed? | It should be classified as closed. |
| How would you code a dislocation and fracture of the same bone? | It would be coded as a fracture only. |
| What is an open fracture? | An open fracture describes a fracture site exposed to the outside elements. Do not code unless documented in the record. |
| Would you code a small puncture wound as open or closed when coding a fracture? | Open-If the fracture site is exposed to air it is considered an open fracture. |
| If a physician treats a closed fracture with a "open" incisional treatment, what would you code? | The approach for treatment should not be confused with an open fracture. |
| How long are fractures coded? | As long as active care is rendered. |
| If a patient is receiving routine care to the fracture site after active care how would this care be coded? | After care subcategories V54.1 etc are reported after the patient ends active treatment of the fracture and is receiving routine care during the healing or the recovery phase. |
| What should you code if a complication occurs during healing or recovery phase? | You would use the appropriate complication code for malunion 733.81 or nonunion 733.82 |
| How are multiple fractures coded? | According to severity. |
| In fractures what does the 5th digit indicate? | The particular bone in the fracture. |
| What does the 4th and 5th digits define in a burn? | The category defines the general location, the 4th digit defines the degree of burn and 5th digit the location of the burn |
| How are burns coded? | By site, severity or degree, and total body surface area |
| What are First Degree burns? | Superficial burns throught only the epidermis. The skin appears intact and no blistering occurs. |
| What is a good example of a first degree burn? | Sunburn |
| What is a Second Degree burn? | A partial thickness burn involving te epidermis and dermis. They usually blister and fill with fluid exudate. |
| What is a Third Degree burn? | Involves the epidermis, dermis, and varying levels of the subcutaneous tissue and underlying structures. |
| Wht are non healing burns coded as? | Acute burns |
| Wht is necrosis of burned skin coded as? | Non-healed burn |
| When there is deep necrosis of underlying tissue. This is reported with ______ | A fourth digit (4) without mention of body part and (5) with mention of loss of body part. |
| How do you code the deepth of the burn? | Always code the greatest dept of the burn in given category/anatomical area. |
| How do you code multiple burns? | Sequence first the diagnosis that reflects the highest degree of burn. |
| When should Category 946 for burns of multiple specified sites be used? | Only if the locations of the burns are not documented. |
| How are complications coded with burns? | Complications such as infrections, associaed injuries, and co-morbid conditions should be coded in addition to the burn codes because they may influence healing. |
| How do you code burns that are scattered over a single anatomic site. | Category 946 Burns of multiple specified sites is used when multiple burns have been identified across multiple sites and there is not enough space to report the multiple codes. |
| When are codes from category 948 which classifies burns according to the extent of body surface involved used? | When the site of the burn is not specified or when there is need for additional data. Also, used when there are burns over 20% of the body. |
| To determine the TBSA-Total Body Surface Area in a burn the Rule of _____ is used. | Nines |
| What is the Table of Drugs and Chemicals used for? | It organizes codes associated with specific substances. Used to locate the E code for a specific drug or chemical. |
| How many codes are used to report an adverse effect with a drug or chemical. | Two, one to report the adverse effect of a drug or chemical and one to report the circumstances. |
| What do Accidental Poisoning E Codes identify? | The identify the accidental ingestion of drugs for incorrect use in the medical or surgical procedures, incorrect administration fro ingestion of the drug or inadvertent or accidental overdose. |
| What do Therapeutic E Codes identify? | They indicate an adverse effect or reaction to a drug that was administered correctly ether therapeutically or prophylactically. |
| What do Suicide Attempt E Codes identify? | They indicate the effects of the drugs or substances taken to cause self inflicted injury or to attempt suicide. |
| What do Assault E Codes identify? | They indicate drugs or substances "purposely inflicted" by another person to cause harm, injury, or death. |
| What are undetermined E Codes? | They are used and applied when the cause of poisoning or injury is unknown. |
| How do you code an adverse reaction with a drug? | First, code the manifectation (s) and second , code the drug causing the reaction. |
| When do you report code 995.2 Other and unspecified adverse effect of drug, medicinal and biological substance? | It is reported with ther is no documentation of speific symptoms associated with the adverse reaction. |
| How would you code poisoning whtn the wrong drug or an incorrect drug is ingested? | First, code from the poisoning column identifying the drug Second, code the condition, manifestations that resulted from the poisoning Third, code an E code from the Table of Drugs and Chemicals. |
| How do you code a complication from medical or surgical care that initiates a visit to the porvider's office or an admission to the hospital? | The complication code is the primary diagnosis and the second code is for the infection (organism) |
Created by:
gbelflower