July 25, 2016

Where There’s Smoke, There’s Fire: Relevant ICD-10 Codes

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Excessive heat warnings and heat advisories have been published recently for much of the Great Plains, Mississippi Valley, Midwest, Ohio Valley, Mid-Atlantic states, and Southern U.S., according to the National Weather Service. 

The United States has also experienced dry weather this summer, and some areas are in exceptional drought, such as Southern California. These droughts also bring fire risk. 

A number of smokejumpers have worked forest fires already this season. The smokejumpers, firefighters who parachute in to remote locations where forest fires are raging, are a national resource for the U.S. Forest Service. This service was proposed in 1934 as an efficient method to put resources in position to attack forest fires. The program began in 1939 and was first utilized in Idaho’s Nez Perce National Forest in 1940. 

The U.S. Forest Service today employs 320 smokejumpers and 10,000 professional firefighters. Their bases are found in Redding, Calif., Redmond, Ore., Winthrop, Wash., McCall, Idaho, Grangeville, Idaho, West Yellowstone, Mont., and Missoula, Mont. 

Let’s look at how ICD-10-CM handles smoke and fire. Burns are the obvious potential injury. Such injuries are found in the range of T20 – T25, with the instructional note to add the extent of body surface involved with the burn using categories T31 or T32.   

Burns are specified as being due to a heat source or due to chemicals. The heat sources may include fire, hot appliance, electricity, or radiation. Corrosions are burns due to chemicals, which are included in the same range as the thermal burns. Complications of thermal burns include bleeding, infection, shock, kidney failure, and other, all of which are assigned separately. Note that sunburns (L55.-) are not found in Chapter 19 (Injury, Poisoning, and Certain Other Consequences of External Causes).    

Smoke inhalation is another injury that can be sustained by these fearless firefighters. Smoke inhalation is coded as T59.811 (toxic effect of smoke, accidental) in this situation. This smoke inhalation has nothing in common with the toxic effects of smoking. Since this code is a poisoning code, the manifestation of the smoke inhalation should also be coded. If the manifestation is not known, J70.5 (respiratory conditions due to smoke inhalation) would be assigned.    

The smokejumpers are brought in by helicopter. Additional injuries such as traumatic fractures can be sustained due to a problem with the parachute. Parachutist accidents can be found in the subcategory of V97.2-. The codes for any transportation-related accident with a helicopter are found at V95.0-. The type of accident involving a helicopter include crash, forced landing, collision, fire, explosion, other, and unspecified. External cause codes are from category X01.- (exposure to uncontrolled fire, not in building or structure). This category includes forest fires. The exposure includes flames, smoke, fall due to the uncontrolled fire, being hit by object due to uncontrolled fire, and other exposure. 

These smokejumpers are doing paid work, so their external cause status is Y99.0 or Y99.1 if they are part of the military or U.S. Forest Service. The most likely places of occurrence include the Y92.821 (forest) or Y92.828 (other, which includes swamp, mountain, marsh, prairie, etc.).   

Let’s review the coding of a scenario in which a smokejumper is fighting a wildfire in a Central California forest and sustains bilateral proximal end femoral fractures as he/she parachutes into the fire location, experiencing a “hard landing.” Using the main term of fracture and the site of femur, the upper end (which is synonymous with “proximal” is located with the corresponding codes S72.001A and S72.002A. There is not a bilateral code, so both the left and right fractures are coded separately. There is no mention that the fracture is open, so the ICD-10-CM Official Coding and Reporting Guidelines direct the coder to assume a closed fracture. 

So the episode information indicates that these injuries are closed and that this encounter is for active treatment. The external cause code is V97.22XA (parachutist injured on landing), and it covers the “hard landing” information. The activity code is not very specific, Y93.39 (activity, other, involving climbing, rappelling or jumping off), and the external cause status code is Y99.0 since this patient was working when the injury occurred. The place of occurrence is Y92.821, which is classified as a forest. These codes are not impacted by the update for 2017 and would be the same in 2017.   

As you listen to the news this summer, keep your ears open for word of our smokejumpers, who are risking their lives fighting forest fires for the residents of the affected areas.
Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer

Laurie M. Johnson, MS, RHIA, FAHIMA is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an American Health Information Management Association (AHIMA) approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and makes frequent appearances on Talk Ten Tuesdays.

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