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Hello,
I have a patient coming in for 3 implants due to trauma. He slipped and fell during excersising. How would you code to explain the accident. I have E849.0 because he was at home and then E885.9 for the slip and fall. The CPT code I am using is 21248. What diagnosis code would you use? Thanks for your help.
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Rank: Administration
Joined: 11/21/2012(UTC) Posts: 1,611
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Hi Guest!
E849.0 & E885.9 are actually no longer valid diagnosis codes - they were part of the ICD-9 coding set, but we are on to ICD-10 now since 2015 :)
However, based on what you described, here are some ICD-10 coding options for you:
First, for the loss of teeth due to trauma: K08.411 - Partial loss of teeth due to trauma, class I K08.412 - Partial loss of teeth due to trauma, class II K08.413 - Partial loss of teeth due to trauma, class III K08.414 - Partial loss of teeth due to trauma, class IV K08.419 - Partial loss of teeth due to trauma, unspecified class
Also, if applicable: G89.11 - Acute pain due to trauma
For the slip & fall: W01.0XXA - Fall on same level from slipping, tripping and stumbling without subsequent striking against object, initial encounter W01.198A - Fall on same level from slipping, tripping and stumbling with subsequent striking against other object, initial encounter
Most medical insurers won't require the place of occurrence or activity code, but if you do want to include then:
For the activity: Y93.B1 - Activity, exercise machines primarily for muscle strengthening Y93.A1 - Activity, exercise machines primarily for cardiorespiratory conditioning Y93.A9 - Activity, other involving cardiorespiratory exercise Y93.B3 - Activity, free weights
For the place of occurrence:
These get pretty specific. To offer you the best coding option, a few questions for you: 1) was it a single family home, apartment or mobile home? 2) what room/area of the house did it occur?
Hope this helps!
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