Monday, October 29, 2018

Halloween Mishaps

by Dianna Foley, RHIA, CHPS, CCS 

Each of the five children of the Klutz family were involved in mishaps on Halloween keeping both their parents and the local ER busy.  Assign ICD-10-CM diagnosis and external cause codes for each of their injuries.

Egon, the oldest child, kicked off the parade to the ER.  He’d begun trick or treating, and he and his bag of candy went flying onto the cement, when he fell from his skateboard after colliding with a bicyclist on the sidewalk.  Since he had suffered about 30 seconds loss of consciousness, his parents decided to take him to the ER.  The ER doctor examined him for fractures, but concluded Egon had a concussion.

Just as they returned to their single-family two-story brick home, Peter, the middle child, ran home from the next-door neighbor’s trailer holding his left arm, which was bleeding.  He told his parents that he’d been playing in the neighbor’s backyard with their pet goat, when inexplicably, without provocation, the goat bite his left forearm and elbow.  Mr. Klutz put Peter in the car and made a return trip to the ER where the lacerations from the goat bites were cleaned and closed with a few stitches.

Turns out that it was a good thing Mrs. Klutz was at home with Egon since, as no sooner had Mr. Klutz left with Peter, than she got a call that her oldest daughter, Janine, had fallen off a pile of haystacks she’d been climbing in Mr. McGillicuddy’s barn where a Halloween party was being held.  Mrs. Klutz texted Mr. Klutz who was still in the ER with Peter that he should be expecting Janine to arrive shortly.  Upon examination in the ER, Janine was determined to have a Colles fracture of her right wrist.  She was splinted and both she and Peter left with their dad to return home.

Meanwhile, young Raymond was running through the family’s kitchen with a sheet over his head pretending to be a ghost.  He tripped over the dog who was lying in the middle of the kitchen, and immediately began crying.  Mrs. Klutz took one look at the little finger of his left hand, which was bent at an awkward angle, and packed him, Egon, and Dana into the car for yet another ER visit.  They passed Mr. Klutz, Peter, and Janine coming home as they went along the way.  Once at the ER, the doctor performed a reduction of the PIP joint dislocation, splinted the finger, and sent Raymond home.

The nursing staff had given little Dana a lollipop while she was standing in the corridor with her mother waiting for Raymond to be discharged.  At some point, she had pulled the sugary treat off the stick and swallowed it, but she immediately began choking, the lollipop having become stuck in her esophagus.  A quick thinking resident performed a Heimlich maneuver on her, and Dana coughed up the lollipop.  By this time, Raymond was discharged, and Mrs. Klutz took Raymond and Dana back home.  Thus ending the Halloween Mishaps for the Klutz family……at least for this year!

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