Coding, Classification and Reimbursement

When to code "traumatic" rhabdomyolysis

  • 1.  When to code "traumatic" rhabdomyolysis

    Posted 26 days ago
    ​​Hello
    When is it appropriate to code 'traumatic' rhabdomyolysis vs. just rhabdomyolysis?  Appreciate any insight shared.  Thanks ~

    ------------------------------
    Lynn A. Wall, RHIT, CCS
    Interim Coding Supervisor
    Maricopa Integrated Health System
    ------------------------------


  • 2.  RE: When to code "traumatic" rhabdomyolysis

    Posted 26 days ago
    We recently had a case where the attending provider documented "traumatic rhabdomyolysis" in a patient that had been found on the floor for an undetermined number of hours.  We coded this to M62.82 (rhabdomyolysis) instead of T79.6xxx (traumatic rhabdomyolysis).  We spent a lot of time discussing the documentation and the codes among ourselves with some expert physician opinions and we determined that traumatic rhabdomyolysis implies that an external/outside force, such as a crush injury or other traumatic force, causes the muscle cell death represented by code T79,6xxx.  An immobile patient for a prolonged or undetermined period of time, not caused by any outside injury/force, has a passive muscle cell death from slow pressure on the muscle cells, and would not be coded as traumatic rhabdomyolysis.

    T79.6xxx - traumatic rhabdomyolysis, caused by an external or outside force such as a crush injury or other traumatic force;

    M62.82 - rhabdomyolysis, not caused by an external or outside force such as a crush injury or other traumatic force; includes an immobile patient for a prolonged/undetermined period of time, but not caused by outside injury/force.

    This is the way we have determined when to code traumatic rhabdomyolysis, and would be interested in how others have determined.

    ------------------------------
    Janet Baucom, RHIA, CCS
    Director HIM
    ------------------------------



  • 3.  RE: When to code "traumatic" rhabdomyolysis

    Posted 25 days ago
    ​Hi Janet
    Thanks for your reply and explanation.  I agree that there are times when it makes sense to select one vs. the other, independent of what the physician documented.  I submitted a question to AHA CC yesterday and within an hour received a response back stating that the EAB is already in discussions regarding this topic, and a response will be forthcoming.  So more to follow - thanks again!
    Happy Thanksgiving ~

    ------------------------------
    Lynn A. Wall, RHIT, CCS
    Interim Coding Supervisor
    Maricopa Integrated Health System
    ------------------------------



  • 4.  RE: When to code "traumatic" rhabdomyolysis

    Posted 25 days ago
    ​I am glad this is being reviewed by EAB. we have had discussions on this topic also. By definition, prolonged immobilization is considered traumatic.

    CAUSES - There are multiple potential causes of rhabdomyolysis [3-6]; these can be broadly divided into three categories (table 1):

    • Traumatic or muscle compression (eg, crush syndrome or prolonged immobilization)
    • Nontraumatic exertional (eg, marked exertion in untrained individuals, hyperthermia, or metabolic myopathies)
    • Nontraumatic nonexertional (eg, drugs or toxins, infections, or electrolyte disorders)

    we have been querying the provider in cases of prolonged immobolization

    ------------------------------
    Lori Sommervold, RHIA
    Inpatient Coding Coordinator
    Froedtert Hospital
    ------------------------------