The last patient of the day also suffered a marine animal mishap, but this time, a seagull was indirectly to blame.
Bob was out scavenging for seashells and sea glass for his artwork when he spotted a group of seagulls having clams for lunch. The gulls would take off, drop the clams on the rocks to break them, then swoop in and consume the exposed inner clam.
Not all of the seagulls were on target and not all of the clams simply broke open. Bob had the misfortune of stepping on a sliver of clam shell, which sliced open the bottom of his bare foot. Of course, Bob was forced to flee the beach, picking up plenty of sand and other debris along the way.
We know Bob suffered a laceration to the bottom of his foot. Were his toes involved? If yes, we'll need to add a code or codes for those injuries. Luckily for Bob, he only lacerated his foot. However, some of the sand remained in the cut, and Dr. Shore had to remove it.
We also need to know which foot Bob injured and the encounter type. In Dr. Shore's notes, he documented an initial visit for a 3 cm laceration of the left foot with foreign material.
That gives us code S91.322A (laceration with foreign body, left foot, initial encounter).
Be aware that the codes will vary by location on the body Laterality Type of wound With or without foreign body. We can also report some external cause codes for Bob, including:
- W22.8xxA, striking against or struck by other objects, initial encounter Y92.832, beach as the place of occurrence of the external cause Y93.01, activity, walking, marching and hiking Y99.0, civilian activity done for income or pay
A quick word about the first and last codes on this list. When you look up stepping on an object in the Alphabetic Index, you are directed to W22.8. That's the code we'll use even though the definition doesn't seem exactly correct.
The Y99.0 code is open to debate a little, too. Bob said he was looking for material for his artwork. We would report Y99.0 if he sells his artwork because scavenging shells could be considered a work activity. If he creates art for art's sake, we would use Y99.8 (other external cause status).
Just remember the next time you're at the beach: avoid the jellyfish, don't poke the marine life, and stay away from seagulls.