Ice skates to x-rays coding challenge

Feb. 19, 2018 / By Rebecca Caux-Harry

Let’s say there’s this not-so-young-anymore woman who was frustrated by a long bout of a winter cold/flu. Upon recovery, she is asked by some friends if she wants to go ice skating. Eager to visit the outside world again, she agrees, but warns them that she hasn’t ice skated since childhood. Reassured by said friends that this won’t be a problem, the event is set.

Now, I’m not going to specify how many years it’s been since childhood, but rest assured, there have been many. Growing up in Northern Indiana with a pond across the street, I spent winters on skates. The “big kids” would clear the snow from the ice, making mounds of snow scattered around the pond. One end would be sectioned off for the hockey players. Ice depth was tested, and once thick enough, the neighborhood enjoyed the frozen pond. While learning to skate, there was always a mound of snow to land on, or plow into when I had lost control. 

Well, the present day experience wasn’t at an outdoor pond with rough ice. There were also no mounds of soft snow to cushion an awkward landing. This was an indoor skating rink with ice smoothed by a machine, but well rutted by skaters. For some reason, it didn’t occur to me that there might be an injury. Really, not once. There, of course, was an injury. After successfully skating for about an hour and a half, I gained confidence. Then I fell, really hard. I had forgotten how hard ice is. 

Later that day, in urgent care, I was evaluated and had x-rays (wrist, three views) and was diagnosed with a fracture of the right distal radius and immobilized in a temporary cast. I am right-handed. The urgent care visit was an Expanded Problem Focused history, single system exam and moderate medical decision making. This was visit one. 

Several days later, I went for my initial visit with an orthopedic surgeon. I had more x-rays (wrist, three views) and a similar evaluation. At the end of the visit, I was immobilized in a new cast. By the way, my cast is green fiberglass and the materials are made by 3M. Small world, right? This was visit two. One and a half weeks later, I had visit number three. During this visit, I had a two-view wrist x-ray and a long discussion with the surgeon about the potential need for surgery.  There was no exam. 

Today, I had visit four, which consisted of more x-rays (wrist, two views), an evaluation of the fit of my cast and the decision by the surgeon to remove my cast and do a physical exam of my lower right arm. His decision, after much prodding, was to put me into a removable cast. While I’m still doing most of my typing with my left hand, I was able to move my mouse back to the right side of my computer.  I feel a wonderful sense of freedom. 

What are the correct CPTs and ICDs for the four visits?   I’ll compare your answers to the bills I receive.

Rebecca Caux-Harry, CPC, is the CodeRyte product specialist for cardiology with 3M Health Information Systems.

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