Monday, May 13, 2019

Field Trip Fiascos

by Dianna Foley, RHIA, CHPS, CCS 

Test your ICD-10-CM external cause coding skills with this short scenario.  Try coding any ICD-10-PCS and CPT as appropriate.

Each of the Klutz children was headed on a class field trip during the month of May.  Not surprisingly, each of them suffered some type of injury while on the outing.  Here is what happened.

Egon’s civics class went to the county courthouse to see the criminal justice system in action.  He was the last one off the bus, and ran up the marble steps to catch up with his group when he slipped and fell.  It was a foggy morning, thus making the marble very slippery.  He ended up with contusions on both knees and elbows.  Luckily, no ER trip was deemed necessary and he was able to participate in the remainder of the day without further incident.

Little Dana did not fare as well on her outing.  Her preschool class went to the Children’s Zoo.  In the petting zoo area, Dana was trying to pet a goat with one hand, while holding food pellets behind her back with the other hand.  Another goat came up behind her, and bit her left hand trying to get the food.  She ended up with a laceration on her left hand; and for safety, a chaperone took her to the ER where Mrs. Klutz joined them.  The ER doc irrigated Dana’s 2 cm. laceration and did a simple repair.  Then little Dana was allowed to go home with her mother.

Janine’s English literature class went to the public library for their field trip.  She was kneeling down to get a book off the bottom shelf when she was struck by a rather large book, which another student had been trying to get off the top shelf.  It was heavier than the student expected, and when he could not catch the book, it crashed down on Janine’s neck and across her entire upper back.  While she ended up being bruised and sore, she recovered quickly.  

The local television station was the location for Raymond’s field trip with his class.  He was walking along with his group when he was distracted by the “green” screen and ended up tripping and falling over a cable that was stretched along the floor.  He was limping after he got home later, so Mr. Klutz took him to the ER where he was diagnosed with a mild left ankle sprain.  Rest, ice, and elevation were recommended for a day or two, and it was not long before Raymond was back to his old self.

Peter’s class spent the day at the museum.  At the lunch, Peter was getting some change from his pocket to get a beverage from the vending machine, when he dropped a quarter.  As Peter reached down to pick it up, another child accidentally stepped down hard on his right index finger, crushing it under his shoe.  Peter experienced immediate pain and swelling of the finger, and it was decided that he needed to go to the ER.  Mrs. Klutz met Peter at the ER, where an x-ray showed a distal, right index finger fracture.  Due to the closed nature of the fracture, the ER doctor decided to perform a closed manipulation of the displaced fracture.  A splint was then applied and then Peter was discharged home with his mother.

Each of the children’s teachers breathed a sigh of relief when the field trips were over.  Glad for the relatively minor injuries as far as the Klutz children go…at least for this year’s trips!
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  1. I need help wrapping my brain around the goat bite. Why is it a laceration instead of an open bite? I've been under the impression if it requires closure it is an open bite.

    1. Good point. The open bite of the left hand code S61.452A would be the better choice for this scenario. Even though called a laceration, it was an animal bite.