Coding up a Storm

With Hurricane Florence having made landfall in the Carolinas last week, here are some quick helpful hurricane coding hints for the coders out there.

General Guidelines

  1. Most codes for Hurricanes and other hurricane-related external causes are typically found within Exposure to Forces of Nature: X30-X39. Be sure to pay attention to the notes included with each code! Specificity is king, so details matter. Storm surges and Tidal Waves aren’t the same thing.
    X38.0 - Hurricane (includes Storm Surge and Typhoon)
    X37.4 - Tidal Wave (Tsunami) 
  2. Sequencing matters! External Causes are always coded after morbidity codes. Codes for hurricanes and other catastrophic events take priority over other external causes with the exception of child/adult abuse and terrorism.
  3. Do not forget episode of care extensions. These track the patient’s progress as they work thru their treatment. These are initial (A), subsequent (D), or sequela (S) with the exception of fracture care codes.
  4. Activities and places of occurrence codes are also vitally important. These codes give researchers and administrators good information for crisis and disaster planning. Did the injury happen with patient still at home? Were they at a shelter or evacuation center? What were they doing when they were injured? These codes are only coded for the patient’s initial treatment.
  5. Causal relationships determine appropriate external codes. Do not assign X37.0 – Hurricane, for injuries not directly caused by the hurricane. Assign the appropriate morbidity code for the injury. However, if it is unclear in the documentation if the injury was directly caused by the hurricane, assume it was and code accordingly.
  6. Assign Z codes where specificity and documentation allows. These codes can further explain reasons for treatment encounters during a disaster scenario, such as:
    Z75.1 - Person awaiting admission to adequate facility elsewhere
    Z75.3 - Unavailability and inaccessibility of health care facilities
    Z75.4 - Unavailability and inaccessibility of other helping agencies
    Z76.2 - Encounter for health supervision and care of other healthy infant and child
    Z76.3 - Healthy person accompanying sick person

Putting It All Together

Jane D. suffered a clean laceration to her right lower leg when the window at the church she was volunteering at during the hurricane burst open due to high winds. Due to shortage of beds, she is awaiting to be transferred to XXX hospital for treatment.

S81.811A - Laceration without foreign body to lower leg, right leg, initial encounter
X37.0A - Hurricane
W25.XXXA - Contact with Sharp Glass
Z75.1 - Person awaiting admission to adequate facility elsewhere
Y92.22 - Religious institution as place of occurrence of external cause
Y99.2 - Volunteer activity

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