Thanksgiving Reminiscences

by Dianna Foley, RHIA, CHPS, CCS, CDIP

Test your ICD-10-CM injury and external cause knowledge by coding the scenarios below.  If applicable, assign ICD-10-PCS and CPT codes.

This year, with the pandemic finally over and the weather cooperating for travel, both sets of the Klutz children’s grandparents were able to come to the Klutz family home, a beautifully restored single-family home for Thanksgiving. As usual, the children’s parents, Mr. and Mrs. Klutz, were keeping their fingers crossed for an uneventful, injury-free day.

The Klutz children, Egon, Janine, Raymond, Peter, and little Dana, were excited to have their grandparents visiting. They loved to hear stories of when their grandparents were little. This year, while the turkey was cooking in the oven and filling the house with an appetizing aroma, the children asked if any of their grandparents had a memorable Thanksgiving story to share. It turns out that each of them did, and not surprisingly, each story involved some type of accident.

Grandma Klutz kicked things off by recalling a Thanksgiving holiday when her five older brothers and some neighborhood friends were playing touch football in the backyard of their house with a frozen turkey. As she remembers, one of the boys tossed the turkey which hit her oldest brother right in the face breaking his nose! At the hospital, her brother, Henry, was placed in observation prior to going to surgery for a closed reduction of his nasal bone fracture along with a splint application.

Next, Granddad Clodhopper related that the Thanksgiving when he was nine, his great-aunt Martha had been taking the turkey (a whooping 25 pounder) out of the oven in the farmhouse kitchen, when her hand slipped tipping the roasting pan, and resulted in hot turkey juice and fat splashing on her feet (she was the original barefoot cook). She avoided going to the hospital for her second-degree burns on her bilateral feet by running cool water in the bathtub and soaking her feet for half an hour and then applying some aloe to them. A gauze wrap was placed around her feet, and she was able to join the rest of the family for dinner.     

Then, Grandpa Klutz recounted his Thanksgiving story. He and Grandma Klutz were celebrating their first Thanksgiving together in their tiny one-bedroom apartment. Unfortunately, he had never carved a turkey before, and not realizing how sharp the knife was, he ended up cutting his left thumb as he was carving the turkey in the kitchen. He had to go to the ER and get stitches. Luckily, no tendons were cut, but he did need three subcutaneous stitches deep in the wound with 12 skin sutures for the 5 cm. laceration repair.

Finally, it was Granny Clodhopper’s turn to regale the children with her remembrance of a Thanksgiving past. Granny explained that she had a boyfriend she had been dating for a few months, so she invited him to come for Thanksgiving dinner. When he arrived for dinner, her cousin Lucille happened to answer the door and was shocked to see the boy she was dating at the door. Apparently, he had been dating both Lucille and Granny at the same time. Lucille was so angry, she swung her arm, and catching the boy off-guard, hit him resulting in a black eye. His left eye was swelling up fast, so Granny took pity on him and gave him a bag of frozen peas to put on it before he headed back home. Janine asked Granny what had become of the boy. Mrs. Klutz was the only one who caught the wink from Granddad Clodhopper as Granny glanced at him. Granny said that was a story for another day.

Dinner was ready now that the stories were finished and the entire Klutz clan enjoyed an accident-free, happy Thanksgiving meal together. All were grateful for no injuries…at least this year!    

Click HERE for the assessment and answers.

 

Infusion and Injection Coding-Part 5

For the past several months “Spotlight on CPT” has presented information for coding of injections and infusions. This final installment on this topic will present several scenarios as well as the rationale for code assignment.

When coding for infusions and injections, it can help coding professionals to assign the correct codes if they ask two questions? What is the primary (initial) service, and are there any other services that should be captured?

Let’s look at this example.

A patient is receiving a 2 mg/mL IV of Zithromax for treatment of her community-acquired pneumonia. It runs from 11:34 -1:04 as an IVBP in Normal Saline (0.9% sodium chloride).

What code(s) should be assigned?

96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis, initial, up to 1 hr.

This is the only code that should be assigned. The total time of the infusion was 90 minutes. Criteria is met to assign 96365 but not the add-on code for an additional hour since the infusion did not run more than 30 additional minutes. Remember that no code for the hydration fluid should be assigned as it is the mechanism for the drug administration.

Here’s another example.

An IV infusion runs for 43 minutes. Twenty minutes later, an IV push of the same medication is performed. The coding was assigned as follows:

96365-IV infusion; initial, up to 1 hr.

96376-IV push, each additional sequential IV push of same substance/drug

Is this correct? No, not enough time elapsed between the infusion and the push to be permitted to code for the push (needed to be at least 31 minutes). The only code that should be assigned is 96365 for the infusion.

Example:

A patient come to the ER at 10:30 p.m. The physician is concerned the patient may be septic, and an IV line is established immediately with fluid TKO. He gets a push of antibiotic at 10:48 p.m. over 12 minutes. Patient goes to observation at 12:45 a.m. At 1:10 a.m. the patient gets another IVP of the same medication again for 12 minutes. How should this be coded?

96374 IV push; single or initial substance/drug

+96376 IV push each sequential IVP of the same substance/drug provided in a facility

These are the correct codes. Remember, this would not be considered two initial services since ER to observation is just one encounter. Also, the fluid administration cannot be separately coded since it was given to keep the line open.

Now, light has been shed on coding injections and infusions.

 

About the Author

Dianna Foley, RHIA, CHPS, CCS, CDIP, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as Eastern Gateway Community College’s program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.