The Medical Coding Case: A 4-year-old is brought into the ED crying. He cannot bend his left arm after his older sister pulled it. The physician performs an X-ray and it shows the patient has a dislocated nursemaid’s elbow. The ED physician reduces the elbow successfully. The patient is able to move his arm again. What ICD-10-CM codes are reported? Select one from the following:

A) S53.095A, Y93.89
B) S53.032S, Y93.89
C) S53.095S, Y93.89
D) S53.032A, Y93.89

The first thing I do is l look and it’s the left arm right here, and his older sister pulled it. They did an X-ray and it shows the patient has a dislocated nursemaid’s elbow. A nursemaid’s elbow, little kids, they have really soft ligament and it doesn’t take much to pull the bones out of the socket. I mean, I did it to my little sister fooling around when I was a kid, and I did it to my daughter rocking her with arms and I pulled both out of the sockets and had to take her to the emergency room.

What the physician did was reduce the elbow, which means he just manipulated it, pushed it back into place. So, we will go and look at the diagnosis codes. From here, the correct answer is the S53.032A, and what you will do is go to the Alpha Index first and you’re going to look up nursemaid’s elbow. That’s exactly how it is in the ICD-10 and it will come out as S53.03- and then you go to the Tabular index. The sixth character 2 is reported for the left elbow; if it was 1, it would be the right as we had seen previously. Then, “A” because it was an initial encounter.

The Alpha Index gives you the bulk of the code, the S53.03- when you look up nursemaid’s elbow. Then, when you go to the Tabular, you will look up their code and then you look and see what digit represents the left elbow, and because it is an initial encounter you would add the “A.” The second part of this is the patient’s arm was injured due to a sister pulling on it. In your ICD-10 manual, you have an Index of external causes and I put big tabs that will say “external causes, neoplasm” so I can flip to it. And when I went to that “external causes” I look for pulling excessive.

In my mind, Y93.83 is the children were horsing, playing around, and the Y93.89 means that it was unspecified. But we have no information if the children were playing and roughhousing as the Y93.83 would indicate, it just said that the sister pulled his elbow; so we have to use the 89 which is an unspecified diagnosis.

So the answer is: D) S53.032A, Y93.89…

Rationale: In the ICD-10-CM Alphabetic Index, look for Nursemaid’s elbow S53.03-. In the Tabular List, sixth character 2 is reported for the left elbow and seventh character A is applied for the initial encounter.

The patient’s arm was injured due to his sister pulling on it. In the ICD-10-CM Index to Diseases of External Causes of Injuries, look for Pulling, excessive Y93. In the Tabular List, Y93.89 is reported for other specified. We have no further information other than the sister pulled the arm.

So, hopefully, that makes sense to you, but there are different sections of the ICD-10 manual like I said, the neoplasm, external causes, just different things and you want to make sure that you have those Tabbed ahead of that, and then you just look for those keywords, like “pulling” or “nursemaid’s elbow” and things like that, and it really will walk you right through it. If it’s not specified, I mean honestly, in my mind, they were horsing around, but I can only assume that because if it wasn’t documented that way, we cannot code it that way. So, hopefully, that made sense. If you have any questions, post them below in the comments area.