March Misery

by Dianna Foley, RHIA, CHPS, CCS 


Test your ICD-10-CM external cause coding skills with this short scenario.

March brought a new set of health problems to the children of the Klutz family.  Each child had a condition that required something be removed beginning with Peter.  He awoke early on the 1st of March with a throbbing pain in his jaw.  His mother made an emergency appointment with the dentist who diagnosed a very carious tooth, which was going to necessitate pulling.  Fortunately, there did not appear to be an infection, so the dentist was able to use forceps to pull the lower molar that day.  Antibiotics were prescribed as a precaution. 

By the weekend, Peter was feeling much better, but his older sister, Janine, was now complaining of a dull abdominal pain.  When Mr. Klutz asked her where it was hurting, she pointed to the right lower quadrant.  When there was no relief, he took her to the emergency room, and after testing, the diagnosis was acute appendicitis.  Janine was placed in observation with laparoscopic surgery scheduled for later that evening.  Her appendix was removed, and after some antibiotics, she was discharged home the next day.  

Janine’s recovery was going well, when mid-month the next Klutz child started to complain of a sore throat.  Raymond was feverish and refusing to eat which was highly irregular for him, so his mother took him to the Minute Clinic.  There they found twelve-year-old Raymond’s tonsils were very enlarged and acutely inflamed and directed him to the emergency department.  From the ER, a second Klutz child was placed in observation, and scheduled for surgery, this time for a tonsillectomy.  Raymond did very well after surgery and went home the next day.

Egon started limping during the last week of the month and when he was seen by his family doctor, it was discovered that he had an ingrown toenail on his great left toe.  The doctor was able to perform a wedge excision of the skin around the nail during the office visit.  He gave Mrs. Klutz a prescription for an antibiotic as the area had seemed highly inflamed.

All the children were recovering nicely, and by the last day of the month, Mr. and Mrs. Klutz thought that perhaps little Dana was going to be the only one without a problem.  Of course, they were wrong once again, as that evening, Dana started to complain of a severe pain in her nose.  There was a bit of epistaxis as well, so her mother took her to the ER.  There a bean was found to be lodged up in the nose.  The children had been helping Mrs. Klutz plant some seeds to begin getting ready for spring planting and little Dana had put one up her nose.  An ENT was called and performed an endoscopic removal of the bean there in the ER.  After a period of observation, the doctors determined little Dana could go home.

With all the children home and safe, Mr. and Mrs. Klutz were relieved that their children’s miseries were over…at least for the time being!



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