Be Careful of Nonvenomous Marine Animals in ICD-10-CM

When a person comes in contact with a nonvenomous marine animal and sustains injuries, there should be an external cause code for it, right? There probably is, but we need to know certain information about the encounter first in order to assign the appropriate ICD-10-CM code.

It also helps to know what main terms to search for in the Index to External Causes and the pertinent coding guidelines for reporting and sequencing of this external cause code.

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What is a nonvenomous marine animal?

A nonvenomous marine animal is one without fangs, spines, stingers, barbs, or other sharp and nasty body parts, according to Ocean Conservancy. Without these parts, a marine animal cannot puncture and inject venom into its opponent. Nonvenomous marine animals include humpback whales, orcas, dolphins, sea lions, and sharks.

Venomous marine animals, on the other hand, are injectors of venom and include such animals as jellyfish, Portuguese man-of-war, stingrays, sharks, and barracudas, according to Medline Plus.

This reminds me of a story I read recently about an incident between a diver and a whale.

Nonvenomous marine animal “swallows” diver

According to National Geographic, a lobster diver was “swallowed” by a humpback whale. The diver stated the whale sucked him into its mouth before pushing him into total darkness. About 30 seconds later, the whale spit him back out. Following that, the diver was taken to the hospital where he was treated for soft-tissue injuries.

My first thought upon reading this story was that there are external cause codes for injuries caused by orca whales. (Actually, my first thought was that it was amazing that he survived such a horrific experience.)

Coding for contact with orca whales

External cause codes for injuries caused by an orca are found in Chapter 20. External causes of morbidity (V00-Y99), category W56 Contact with nonvenomous marine animal. These codes are classified as bitten by, struck by, and other contact. These codes require a 7th character for the episode of care:

W56.21XA Bitten by orca, initial encounter
W56.21XD Bitten by orca, subsequent encounter
W56.21XS Bitten by orca, sequela
W56.22XA Struck by orca, initial encounter
W56.22XD Struck by orca, subsequent encounter
W56.22XS Struck by orca, sequela
W56.29XA Other contact with orca, initial encounter
W56.29XD Other contact with orca, subsequent encounter
W56.29XS Other contact with orca, sequela

None of these codes fit the description of what took place, however. Why? Because the diver was swallowed by a humpback whale, not an orca. An orca is a killer whale.

Furthermore, unlike orcas, humpback whales have no teeth. Instead, they use the special bristles in their mouths to filter out and retain the krill and small fish they feed on while pushing the water out through the gaps. So the diver was not bitten by the whale.

Finally, there was no mention of the whale striking the diver. In fact, there was no malicious intent on the part of the whale at all. It was merely an accident — a case of being in the wrong place at the wrong time.

The diver did come in contact with the whale. There is no doubt about that.

Now let’s look at the following coding example.

Coding example

A patient is brought into the emergency department. He was lobster diving when he came in contact with a humpback whale. The whale engulfed the diver into its mouth and then spit him out about 30 seconds later after realizing what it had done. The patient is examined and treated for soft-tissue injuries and released to go home. What is the external cause code for this encounter?

Finding the main term in the Index to External Causes

There are two ways to look up external cause codes in the Index to External Causes. One way is to search for the intent, such as Accident or Assault. If the intent is unknown or unspecified, code the intent as accidental intent.

The other way is to search for the causal event, such as Bite or Contact. Once we look up the main term, we must look further at the subterms. The subterms provide more specifics about the encounter.

Common Main Terms used in the Index to External Causes include:

Accident
Activity
Assault
Bite
Burn
Complication
Contact
Drowning
Explosion
Exposure to
Failure
Fall
Forces of nature
Incident
Jump
Legal
Military operation
Misadventure
Place
Radiation
Status
Striking against
Struck by
Suicide
War operations

Now that we know this, let’s locate and verify the correct external cause code for the scenario above.

Contact with humpback whale (ICD-10-CM) – Locate and Verify

To locate the correct code, go to the External Causes Index and look up Contact (accidental)/with/marine/animal W56.89. When we go to the Tabular, there are three codes to choose from:

W56.89XA Other contact with other nonvenomous marine animals, initial encounter
W56.89XD Other contact with other nonvenomous marine animals, subsequent encounter
W56.89XS Other contact with other nonvenomous marine animals, sequela

Since the diver was taken to the hospital following the incident and was receiving active treatment, the appropriate 7th character is “A”.

So our code is:

W56.89XA, Other contact with other nonvenomous marine animals, initial encounter

Codes for other nonvenomous marine animals

If you or someone you know are ever bitten by, struck by, or have other contact with a nonvenomous marine animal (other than an orca and humpback), you can rest easy knowing there are codes for those as well:

Dolphin (W56.0)
Sea lion (W56.1)
Other marine mammals (W56.3)
Shark (W56.4)
Other fish (W56.5)

Documentation and coding guidelines

In the real world of medical coding, the provider’s documentation should specify the patient’s primary diagnosis. If the patient sustained soft-tissue injuries, such as a sprain, strain, and/or contusion, the documentation should indicate the type and location of the injury. There may be multiple soft-tissue injuries throughout the body, which may require several diagnosis codes.

External cause codes are supplemental codes that are not required nationally. However, they are often listed with injury codes.

When assigning codes from category W56, these codes should:

Always be sequenced as secondary codes after the code for the injury/condition
Be listed before activity (what patient was doing), status (civilian or military), and place of occurrence (where it happened) external cause codes
Have a 7th character (A, D, S) to show the episode of care

As for the whale incident, I’m just glad the diver was alright. It sounds like a traumatic ordeal for both involved.

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