January 2017

Chart Conundrums: Love Hurts
By Judy Sturgeon, CCS, CCDS
For The Record
Vol. 29 No. 1 P. 28

With New Year's Day behind us, another Valentine's Day is around the corner, and what better way to express our love of coding than to apply it to the very holiday that is dedicated to amour? In order to do so, we'll need some case scenarios to code. With his sharpened arrows, Cupid disrupts lives, wreaks havoc, and creates heart palpitations.

Case One
A new bride is concerned that she's yet to receive any valentine hints from her normally doting husband. He's late coming home from work and hasn't called. A toxic mixture of emotions, including anger, depression, anxiety, and rejection, fills her body. Did he even remember? Has the marriage already gone stale?

The husband finally arrives, carrying a huge bouquet of roses, a chilled bottle of champagne, and a box of her favorite chocolates. Her prior worries vanish as her heart races with anticipation. She feels giddy as she realizes her love has remembered Valentine's Day after all! She has made a lovely and lavish dinner to share as they celebrate with champagne, and eat the entire box of chocolates for dessert.

The next day, however, comes with a price. They both wake with awful hangovers and agree that some of their symptoms are from overeating. He notices a rose thorn deeply and painfully embedded in his right index finger from clutching the bouquet too tightly while putting it in a vase. She takes him to the urgent care clinic where the physician makes an incision and removes the thorn from the subcutaneous tissue of his finger. The bride sees her therapist to learn how to better manage her chaotic emotions. The result? A series of codes, including the following:

• anger: R45.4;
• situational depression: F43.21;
• anxiety: F41.9;
• social rejection: Z60.4;
• racing heart: R00.0;
• giddiness and dizziness: R42;
• overeating: R632;
• alcohol hangover: F10.120;
• puncture wound, right index finger: S61.240A, W60.XXXA, Y93.89, Y99.0, Y99.8; and
• removal of foreign body from right index finger, open: ICD-10-PCS 0JCJ0ZZ, CPT 20103.

Case Two
Not all affairs of the heart play out so smoothly, however. Let's see what there is to code when Romeo appears to be somewhat less smitten with the holiday than Juliet.

Juliet arrives home from a mentally grueling day at the office. She has her handbag but is frustrated to learn that she has left both her house key and her phone 12 miles away on her desk. She waits impatiently for Bob (not many people name a kid Romeo anymore), who is known for never being on time. Annoyed, she rethinks her original Valentine's Day plan of plying him with a few drinks and trying to re-create the romance that they once shared.

Bob finally stumbles to the door, where he is met by a seething Juliet. Tired and quite surly, he suggests that since she's the one who forgot the key, the only person she should be angry with is herself. Juliet notices that Bob has gotten a head start on the drinking, and Cupid is nowhere in sight. "Fine!" she exclaims. "You start dinner, and I'll go back and get my phone and keys and we'll just forget Valentine's Day until next year!"

As she spins on her heel and storms off, Juliet fails to navigate the curb and trips, falling into the street. A small boy riding by on his bicycle swerves in an attempt to avoid Juliet, but plows into her before he can completely apply the brakes.

The boy is unharmed but Juliet is not as fortunate. She has avoided wearing the bicycle as an accessory, but has seriously injured her right ankle. She is bleeding profusely and in terrible pain, and Bob is filled with concern. He rushes her to the hospital where a lacerated right anterior tibial artery is sutured in the emergency department. Juliet is admitted and hurried to surgery where an open reduction with internal fixation of the open trimalleolar fracture is performed. She has mild acute blood loss anemia but does not require a transfusion.

The first thing Juliet sees when she awakens is Bob's worried face as he breaks into a relieved smile. He holds her hands in his, and they commence to blurt out matching apologies for their earlier argument. "I love you," Juliet professes. "And I love you more," Bob responds.

The cyclist has been loitering outside the hospital. He confirms that Bob and Juliet's love is renewed, and Cupid rides crookedly down the street on his now-battered bicycle with a smirk of satisfaction on his cherubic face.

Meanwhile, the ever-dutiful coder on hand has documented the following:

• open trimalleolar fracture of right ankle: S82.851B;
• acute blood loss anemia: D62;
• laceration of right anterior tibial artery: S85.141A;
• tripping and falling over a curb while walking: W10.1XXA, Y93.01;
• hit by bicycle on the neighborhood street: W20.8XXA, Y93.01, Y92.414;
• suture repair of right anterior tibial artery: 04QP0ZZ; and
• open reduction and internal fixation of right trimalleolar ankle fracture: 0QSJ04Z, 0QSG04Z, 0QSG04Z;

Do you absolutely love coding? Can't get enough of it? Here's one last code: F28 (other specified psychosis).

Happy Valentine's Day, and always do what you love!

— Judy Sturgeon, CCS, CCDS, is the clinical coding/reimbursement compliance manager at Harris County Hospital District in Houston and a contributing editor at For The Record. While her initial education was in medical technology, she has been in hospital coding and compliance for 26 years.