In this season of Halloween, I thought I would code my personal venomous spider experience in ICD-10-CM and use some of those new external cause codes. So here’s my spider story:
I was working down in Tucson, Arizona and our team decided to stay at a beautiful resort out in the desert. When I got out of the shower that first morning, I noticed a large red area on my back above my left shoulder blade and in the center was a small blister. I figured I had been bit by something during the night. But I had meetings the next two days and forgot all about it.
When I returned home that weekend, my husband commented that I had a black spot on my left upper back/shoulder. Over the next couple of days, it grew larger. I traveled to California that next week for work and while there noticed it was getting even larger and that now I had an enlarging black hole in that area (necrotizing fasciitis). When I returned home that Thursday, I saw my doctor who told me that I had been bit by a brown recluse, gave me heavy duty antibiotics (injected and oral) and told me that if the hole got any larger to go to the nearest ER regardless of what city I was in, that I could lose part of my shoulder. After 9 weeks of chills and sweats, the hole slowly closed.
Visit to my primary care doctor:
Enlarging black hole in my left upper back/shoulder (necrotizing fasciitis)
Bit by a brown recluse
M72.6 Necrotizing fasciitis (unknown bacteria)
T63.331A Toxic effect of venom of brown recluse spider, accidental (unintentional)
Y93.84 Activity, sleeping
Y92.59 Other trade areas as the place of occurrence of the external cause
Y99.0 Civilian activity done for income or pay
I always tell providers where their documentation is the brush, their diagnostic coding is the paint, to paint the picture of medical necessity. And in this case, accurate and complete coding helped to determine liability. The hotel eventually paid back the worker’s compensation company for all charges.
Lastly, the brown or brown recluse is indigenous to the Tucson area. If you stay overnight there, check your sheets.
Linda R. Farrington, CPC, CPMA, CPC-I
AAPC Approved ICD-10-CM Trainer
AHIMA Approved ICD-10-CM Trainer
Owner, Instructor, Consultant
“Making Sense of Medical Coding” &
“The Dollars and Sense of Medicine”