by Daniel Land, RHIA, CCS
Director of Compliance Review Services

Consider the Mayflower: A relatively small ship containing 102 passengers and approximately 30 crew members. The journey from England to Massachusetts took 66 days in 1620. The voyage was fraught with rough seas, scant provisions, and harsh living conditions. It is not difficult to imagine that passengers must have sustained numerous injuries associated with the voyage.

For example, history records that John Howland fell overboard during a turbulent storm but managed to grab a line that was trailing in the water and was hauled back aboard safely. There were five deaths at sea, including Dorothy Bradford – the wife of William Bradford, Governor of the Plymouth Colony.

So, let’s use our imagination to create scenarios of life on board the Mayflower and test our ICD-10-CM coding skills. Do you think the codes listed below accurately represent the scenarios? This is an interactive exercise – let me know your thoughts:

Happy Thanksgiving!

Scenario 1

Mary Allerton was taking her morning walk aboard the ship and fell, striking her forehead on the deck. A contusion of her forehead was noted.

  • S0083XA: Contusion to other part of head, initial encounter
  • V9331XA: Fall on board passenger ship, initial encounter
  • Y9301: Activity, walking, marching and hiking
  • Y92814: Boat as the place of occurrence of the external cause
  • Y998: Other external cause status

Scenario 2

John Billington awoke early one morning to discover numerous bites on his left forearm. The bites were not present when he went to sleep the previous night. It was determined that bedbugs were the culprit.

  • S50862A: Insect bite (nonvenomous) of left forearm, initial encounter
  • W57XXXA: Bitten or stung by a nonvenomous insect and other nonvenomous arthropods, initial encounter
  • Y9384: Activity, sleeping
  • Y92814: Boat as the place of occurrence of the external cause
  • Y998: Other external cause status

Scenario 3

Humility Cooper ate her usual lunch of hardtack and pickled fish. She began feeling nauseous later in the day and was vomiting by evening. It was determined that Humility was suffering from food poisoning due to the pickled fish – her favorite food.

  • T6191XA: Toxic effect of unspecified seafood, accidental (unintentional), initial encounter
  • R112: Nausea with vomiting, unspecified
  • Y92814: Boat as the place of occurrence of the external cause

Scenario 4

Two anonymous Pilgrims had a philosophical disagreement that escalated into a brawl. One punched the other who suffered a blackened left eye. Bad behavior, even in 1620!

  • S0012XA: Contusion of left eyelid and periocular area, initial encounter
  • Y042XXA: Assault by strike against or bumped into by another person, initial encounter
  • Y9389: Activity, other specified
  • Y92814: Boat as the place of occurrence of the external cause

Scenario 5

Elizabeth Winslow did not take into account the rough seas when she descended the stairs into the ship’s hold. She fell from the third step from the bottom and developed immediate arm pain. It was determined that she suffered a non-displaced left transverse radial shaft fracture. There were no pain meds and no surgical treatment available. Our ancestors were a hearty lot!

  • S52325A: Non-displaced transverse fracture of shaft of left radius, initial encounter for closed fracture
  • W108XXA: Fall (on) (from) other stairs and steps, initial encounter
  • Y9301: Activity, walking, marching, and hiking
  • Y92814: Boat as the place of occurrence of the external cause

True to its mission, ICD-10-CM offers a broad range of highly specific external causes of morbidity codes. I hope this lighthearted exercise underscores the importance of these codes and the necessity of always selecting the most specific codes possible. Never before have quality coding and quality healthcare aligned so closely. Our coding data must support the ever-increasing quality focus of healthcare. We must be always cognizant of the global impact of coding and CDI and of our pivotal roles in healthcare quality.

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