The Deranged Duck

“Dude, they really do have a code for everything these days, don’t they,” my friend asked. “I mean, do you really need to code the fact some dude got hit by the same duck twice? Did he owe the duck money, or something?” We both chuckled heartedly at this.

With the implementation of ICD-10-CM (International Coding Statistical Classification of Diseases and Related Health Problems, 10th Edition, Clinical Modification) in October 2015, the medical coding world collectively sighed with relief and groaned in despair. The new system was to bring in much needed specificity and it did its job a little too well. With the total diagnoses codes increasing from 14,025 in the previous version (ICD-9-CM) to 69,823 in ICD-10-CM it certainly seems there is a code for everything and the kitchen sink.

My friend was rightly bewildered over the code I showed him in ICD-10:

W61.62XD – Struck by Duck, Subsequent Encounter

And not only can you be struck by a deranged duck, you can also be struck by an ill-tempered orca with a grudge. There’s even a code for being sucked into a jet engine . . . and, yes, there is a subsequent encounter code for that, too.

All kidding aside, external cause of injury coding is a very important aspect to medical coding. Capturing injury-related information using coding data like cause and intent, activity, and place of occurrence, enables the Centers for Disease Control and Prevention (CDC) to track valuable information. This data can be used by other entities to assess injury prevalence, trends, and other risk factors. For example, it might be analyzed that there has been an unusually high number of duck attacks in a given area, which could mean we have a possible duck uprising on our hands. Vive le Canard!

External cause codes are more than just descriptions of how a condition came about. They are further described using the 7th and final character of the code sequence stating what stage the patient is undergoing in their treatment plan.

Initial Encounter (A) codes are used while the patient is receiving active treatment for their condition. For example, surgical treatment, emergency care, or evaluation and continuing treatment by the same or different physician.

Subsequent Encounter (D) codes are used for encounters after the patient has finished active treatment and is receiving routine care for the condition during the healing or recovery phase. For example, cast change or removal, x-rays to check healing status of fractures, medication adjustments, and other aftercare visits following active treatment.

Sequela (S) codes are used for treatment for complications or conditions that arise as a direct result of the initial condition, such as scar formation after a burn, or pain after a fracture that has healed.

Let’s revisit the dastardly duck in the case of John Q.

1. John Q presented to the ED with severe shoulder pain in the right collar bone area. It was determined he suffered a fracture to the acromial end of his right collarbone. He stated a duck flew into him while he was minding his own business doing his morning water aerobics at the local swimming pool.

Diagnoses Codes: (emphasis on External Cause Codes)

-S42.034A – Displace Fracture of Lateral End of Clavicle, Right Side

W61.62XA – Struck by Duck, Initial Encounter

Y93.14 – Water Aerobics, Activity

Y92.34 – Public Swimming Pool, Place of Occurrence

2. John Q presents to his orthopedic surgeon 3 months later for x-rays. His fracture was found to have healed well and the shoulder sling is no longer needed.

Diagnoses Codes: (emphasis on External Cause Codes)

-S42.034D – Displace Fracture of Lateral End of Clavicle, Right Side

W61.62XD – Struck by Duck, Subsequent Encounter

Note: Activity and Place of Occurrence codes do not carry beyond the initial encounter.

3. John Q presents back to his orthopedic surgeon a few months later complaining of an ongoing pain at his injury site. X-rays reveal a properly healed fracture but pain and tenderness were noted upon examination as well as limited range of motion. John Q was diagnosed with adhesive capsulitis as a direct later effect of his clavicle fracture.

Diagnoses Codes: (emphasis on External Cause Codes)

-M75.01 – Adhesive Capsulitis of Right Shoulder

-S42.034S – Displace Fracture of Lateral End of Clavicle, Right Side

W61.62XS – Struck by Duck, Sequela

Note: At this point it is not necessary to code the Duck encounter, but, hey, if you have the information, go for it!

So, John Q’s singular encounter with that possibly drunk duck caused him quite a bit of pain with some lasting residual effects. It’s no laughing matter … seriously.

This single example is rather simple. External Cause codes can get rather complex and aftercare treatment can further muddy the waters, especially when you dive deeper into orthopaedics. But, with a few codes, we Coders can find some humor in our work and bring a few chuckles to the masses.

Like, V91.07XD – Burn Due to Water Skis on Fire, Second Encounter

(I think I’ve ruined the joke.)

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