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Advanced ICD-10 for
Physicians Including
Worker’ s Compensation
and Personal Injury
Advanced ICD-10 for
Physicians Including
Worker’ s Compensation
and Personal Injury
By
Eugene Fukumoto
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2017 by Taylor & Francis Group, LLC

CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Printed on acid-free paper
International Standard Book Number-13: 978-1-138-03290-3 (Hardback)
This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to
publish reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materi-
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Library of Congress Cataloging‑ in‑ Publication Data
Names: Fukumoto, Eugene, author.

Title: Advanced ICD-10 for physicians including worker’s compensation and personal injury /
Eugene Fukumoto.
Description: Boca Raton : Taylor & Francis, 2017. | “A CRC title, part of the Taylor & Francis
imprint, a member of the Taylor & Francis Group, the academic division of T&F Informa plc.” |
Includes bibliographical references.
Identifiers: LCCN 2016040423| ISBN 9781138032903 (paperback) |
ISBN 9781315317342 (ebook)
Subjects: LCSH: Nosology--Code numbers--Problems, exercises, etc. | Medical records--
Code numbers--Case studies.
Classification: LCC RB115 .F85 2017 | DDC 616.001/2--dc23
LC record available at https://lccn.loc.gov/2016040423
Visit the Taylor & Francis Web site at

http://www.taylorandfrancis.com
and the CRC Press Web site at

http://www.crcpress.com
Contents
Preface................................................................................................................ xi
Acknowledgments .......................................................................................... xiii
Other Books by Eugene Fukumoto............................................................... xv
Disclaimer....................................................................................................... xvii
1 Chapter One........................................................................................ 1
Introduction to ICD-10, Including Worker’ s Compensation and Personal
Injury................................................................................................................... 1
ICD-10.............................................................................................................. 2
Reasons to Avoid Relying on GEM Software............................................. 2
2 Chapter Two........................................................................................ 5
Structural Overview of the ICD-10-CM Book.................................................... 5
Code Structure Basics......................................................................................... 6
Using ICD-10 Overview...................................................................................... 6
3 Chapter Three..................................................................................... 9
Components of ICD-10 and Their Usage........................................................... 9
External Causes............................................................................................. 12
Combination Codes....................................................................................... 12
Specialty Crosswalk Enclosed................................................................... 13
Instructional Notations...............................................................................14
Secondary Only Diagnosis Edits...............................................................15
Z Codes and Their Importance in Worker’ s Compensation and Personal
Injury..................................................................................................................16
A Basic Seven-Step Process for Diagnostic Coding..........................................17
A Basic Seven-Step Process Case Example...................................................... 18
4 Chapter Four..................................................................................... 21
Overview of Six-Category System for Injury Coding....................................... 21
Six-Category System: Step-by-Step Process...................................................... 26
Category 1: Find the Correct Z Code........................................................... 26
Category 2: Find the Correct Health Condition Code(s).............................. 27
Category 3: Find the Correct External Cause Code(s) ................................. 28
Category 4: Find the Correct Place of Occurrence Code............................ 30
v
vi ◾ Contents
Category 5: Find the Correct Activity Code................................................. 30

Category 6: Find the Correct Status Code ................................................... 30
5 Chapter Five...................................................................................... 33
Combination Codes.......................................................................................... 33
Cardiovascular System................................................................................... 35
One ICD-10 Code Representing Two ICD-9 Codes................................. 35
One ICD-9 Code Translating into Three ICD-10 Codes.......................... 35
Dermatology/Family Practice and Others.................................................... 36
Emergency Medicine/Hospitalist.................................................................. 36
Endocrinology/Gastroenterologist................................................................ 37
Geriatrics....................................................................................................... 37
Internal Medicine/General Practice.............................................................. 37
Oncology....................................................................................................... 37
Ophthalmology............................................................................................. 38
Orthopedics................................................................................................... 38
Pain Management Specialist......................................................................... 38
Pediatrics....................................................................................................... 38
Podiatry......................................................................................................... 39
Primary Care................................................................................................. 39
Gout........................................................................................................... 39
Lumbago and Sciatica............................................................................... 39
Obstetrics and Gynecology........................................................................... 39
Diabetes in Pregnancy.............................................................................. 39
Complications Specific to Multiple Gestation (O31-)................................ 40
Maternal Care for Malpresentation of Fetus (O32-).................................. 40
Psychiatry and Psychology........................................................................... 40
Pulmonology................................................................................................. 40
Radiology....................................................................................................... 41
Rheumatology and Related........................................................................... 41
Urology.......................................................................................................... 41
ENT (Otolaryngology)................................................................................... 42
Surgery: General............................................................................................ 42
Toxicology/Internal Medicine and General Medicine.................................. 42
Nephrology and Cardiology......................................................................... 43
There Are Many Possible Combination Codes............................................ 43
Other Provider Requirements for ICD-10......................................................... 43
Seventh-Character Codes.............................................................................. 43
Greater Level of Detail Required.................................................................. 44
External Cause of Morbidity Codes (Transport and Other)........................ 44
Other External Causes of Morbidity Code Examples.................................. 45
6 Chapter Six....................................................................................... 47
ICD-10 Coding Guidelines for General and Family Practice (Specific
Coding for Differential Diagnoses)................................................................... 47
Contents ◾ vii
Head/Neck.................................................................................................... 50
Sore Throat................................................................................................ 50
Headache....................................................................................................51
Eye (Vision) Problems............................................................................... 52
Upper Extremity............................................................................................ 53
Shoulder Pain............................................................................................ 53
Elbow Pain................................................................................................ 54
Chest.............................................................................................................. 54
Chest Pain.................................................................................................. 54
Common Respiratory Problems................................................................ 55
Abdomen....................................................................................................... 57
Abdominal Pain......................................................................................... 57
Irritable Bowel Syndrome (IBS)................................................................ 58
Dialysis Status............................................................................................ 59
Spine.............................................................................................................. 59
Back Pain................................................................................................... 59
Subluxation................................................................................................ 60
Neck Pain.................................................................................................. 60
Pelvis...............................................................................................................61
Rectal Pain and Bleeding...........................................................................61
Urinary Tract Infection, Site Not Specified N39.0.....................................61
Prostatitis................................................................................................... 62
Testicular Pain........................................................................................... 62
Lower Extremity............................................................................................ 63
Knee Pain.................................................................................................. 63
Generalized................................................................................................... 64
Cardiovascular System............................................................................... 64
Neurology.................................................................................................. 66
Neuro/Psychiatry........................................................................................67
General Pain.............................................................................................. 68
Diabetes..................................................................................................... 68
Obesity....................................................................................................... 69
Malnutrition............................................................................................... 70
Hyperlipidemia.......................................................................................... 70
Dermatitis and Skin Related...................................................................... 71
Oncology................................................................................................... 72
Women’ s Health.........................................................................................74
Other Conditions....................................................................................... 76
7 Chapter Seven................................................................................... 79
Worker’s Compensation, Personal Injury, and Drug or Chemical Induced
Diabetes............................................................................................................. 79
Diabetes Mellitus Discussion............................................................................ 80
Diabetes Mellitus in Pregnancy, Childbirth, and the Puerperium............... 82
viii ◾ Contents
Use of Flowcharts.......................................................................................... 82
Diabetes Flowcharts ...................................................................................... 83
ICD-10-CM Draft Release Expert Edition: Diabetes Mellitus Section�� 128
8 Chapter Eight.................................................................................. 139
Worker’ s Compensation and Personal Injury Billing Guide..........................139
Code Extensions for External Cause Code.................................................139
Coding Injuries.............................................................................................140
Coding of Traumatic Fractures....................................................................141
Injury Coding Can Be a Big Challenge.......................................................141
Place of Occurrence and Activity Codes.....................................................141
Encounter Codes..........................................................................................142
Using the Crosswalk��143
Personal Injury Example Case 1 .................................................................143
Worker’ s Compensation Example Case 2...................................................144
Worker’ s Compensation Example Case 3...................................................148
Seventh-Character Codes for Fracture��150
Billing for Physical Therapy.........................................................................150
Procedure.................................................................................................153
Billing for Injections.....................................................................................154
Arthrocentesis...........................................................................................155
Billing for X-Rays.........................................................................................156
Billing for Minor Surgical Procedures.........................................................157
Worker’ s Compensation and Personal Injury Patients............................159
Commonly Used Diagnosis Codes..................................................................159
Abdominal Pain: ICD-10 Category R10.......................................................159
Carpal Tunnel Syndrome in Worker’ s Compensation and Personal
Injury............................................................................................................160
Psychological Discussion.............................................................................160
9 Chapter Nine....................................................................................163
Cumulative Trauma..........................................................................................163
Compensable Consequences versus Cumulative Trauma...............................165
10 Chapter Ten.....................................................................................167
Causation and Apportionment in Worker’s Compensation and Personal
Injury................................................................................................................167
Causation......................................................................................................167
Apportionment.........................................................................................167
11 Chapter Eleven.................................................................................171
Dilemma of the Independent Medical Evaluator (The Law of
Unintended Consequences).............................................................................171
Overview for Independent Medical Evaluators..............................................172
Contents ◾ ix
12 Chapter Twelve................................................................................175
Multi-Specialty Discussions..............................................................................175
Whiplash Injury Case...................................................................................175
How a Provider Might Use ICD-10..........................................................175
Depression: The Leading Cause of Disability Worldwide..........................177
ICD-10 and Pain Coding............................................................................. 180
How a Provider Might Use ICD-10......................................................... 180
Pain Management Case............................................................................... 186
How a Provider Might Use ICD-10......................................................... 186
Diagnosis Coding.....................................................................................187
Adverse Effects of Medication.....................................................................190
Codes........................................................................................................190
Final Coding.............................................................................................192
Orthopedic Examination with Emphasis on Apportionment and How
ICD-10 Helps................................................................................................192
Coding......................................................................................................193
Medical-Legal Sleep Disorder Evaluation....................................................194
Discussion....................................................................................................195
ICD-10: Waiting for the Other Shoe to Drop..............................................195
Orthopedic Independent Medical Evaluation: Complicated by Staph
Infection following Surgery.........................................................................197
Orthopedic Independent Medical Evaluation Involving Surgical Coding....198
Appendix............................................................................................... 201
Index..................................................................................................... 271
Preface
The implementation of ICD-10 is the biggest change that Eugene Fukumoto has
seen in over 30 years of billing and coding. It will be a continuing challenge
to make this transition. It is very important that providers understand that their
documentation is key and that they have to know that their documentation must
support claims submitted.
The changes in ICD-10 are especially daunting for Worker’ s Compensation
and Personal Injury because of the specific knowledge of injury codes required,
as well as the medical-legal complications.
There are conflicting statements in ICD-10. On the one hand, there is a state-
ment that there is no national mandatory ICD-10 External Cause reporting, unless
it is required per state-based reporting mandate. On the other hand, many of
the ICD-10 codes, such as sprains, are S codes, which by definition are External
Cause codes.
We don’ t know how claims will be processed, but it is very important that
providers be aware of these conflicting statements. Med-legal issues will probably
require case law for resolution.
Eugene Fukumoto has spent most of his career in medical billing and collect-
ing. As we transition into ICD-10, he saw a need to train doctors and their staff
on how to get the bill “ out the door.” That is the purpose of this book, to help
your entire staff understand ICD-10 and how it is used with CPT codes, the CMS
Form 1500, and the documentation in the patient’s status.
Once you go through the step-by-step process, the Six-Category System, and
work with Eugene’ s examples, it will make it very clear. Eugene and his team are
here to help you beyond the book, as well, with online training, blogs, and other
tools.
The intention is to give you a credible book with a simple system to make the
actual billing process easier.
Simply put, what Eugene is trying to accomplish here is to help you “ get the
bill out the door” !
Dr. Donna Meeks
Dr. Dan Farris
xi
Acknowledgments
The author would like to thank the following people for their support and contri-
butions to this book.
Dr. Michael Smith , Orthopedic Surgeon

Harvard Fellow
Past President of the California Society of Industrial Medical Specialists
Independent Medical Evaluator
Dr. Vincent Sghiatti , Family and General Practice

UCLA Fellow
Board Certified in Family Practice
Pennsylvania State University, College of Medicine
Dr. Donna Meeks, Dr. Dan Farris , DC

Created one of the largest Chiropractic clinics in California
Opened the first California sleep laboratory with a neurologist for Worker’ s
Compensation per the American Medical Association Guides
Created MF University for online training/live seminars for MDs, attorneys, and
DCs
xiii
Other Books by
Eugene Fukumoto
Conquering ICD-10— For Chiropractors

Conquering ICD-10— For Family Physicians and General Practice
Conquering ICD-10— Worker’ s Compensation and Personal Injury (First
Edition)
Online Courses by Eugene Fukumoto:

(Sponsored by MF University)
Conquering ICD-10: Module 1
Conquering ICD-10: Module 2— Advanced Concepts
For more info, visit Eugene at:

www.icd10center.com
www.mededonline.myicourse.com
www.dctodconline.myicourse.com
www.legaledonline.myicourse.com
xv
Disclaimer
The purpose of this book is to educate the physician, as well as the billing
and coding staff, on ICD-10, so that they can properly document all necessary
information to accurately and thoroughly complete the billing process. Also, it
is intended to give the physician an understanding of the proper implementa-
tion of ICD-10 and the possible repercussions of improper coding regarding
all insurance billing, including Medicare, Group Insurance, HMOs, Worker’ s
Compensation, and Personal Injury.
The ICD-10-CM Draft Release is not complete and is still evolving. This is
another reason why you should be cautious about using the free ICD-9 to ICD-10
crossover packages. There are 21 sections now in ICD-10 and it is being revised
as we speak, so you may be able to use a free crossover today, and next week it
will be different.
This book was prepared as a service to the providers and billing and cod-
ing staff and is not intended to grant rights or impose obligations. This book
may contain references or links to statutes, regulations, or other policy materials.
The information provided is only intended to be a general summary. It is not
intended to take the place of either the written law or regulations. We encourage
readers to review the specific statutes, regulations, and other interpretive materi-
als for a full and accurate statement of their contents.
xvii
Chapter 1
Chapter One
Introduction to ICD-10, Including Worker’ s

Compensation and Personal Injury
The purpose of this book is to educate physicians on ICD-10, so that they can
properly document all necessary information that the billing staff will require
to accurately and thoroughly complete the billing process. Also, it is intended
to give physicians an understanding of the proper implementation of ICD-10
and the possible repercussions of improper coding regarding all insurance bill-
ing, including Medicare, Group Insurance, HMO’ s, Worker’ s Compensation, and
Personal Injury.
Updated coding for the ICD-10-CM book, 2017 edition, was analyzed for the
creation of this book.
To the best of our knowledge, the first edition of this book was the first pub-
lication regarding ICD-10 and its use in Worker’ s Compensation and Personal
Injury.
This book starts with an overview in Chapter 2 of the basic concepts of ICD-
10. As you progress through the book, greater detail and explanation are given.
This book was designed to give you more complex situations as you progress.
Therefore, it is advised that you start at the beginning and read through the
entire book.
Although this book includes discussion of ICD-10 as it applies to all types
of insurance billing, Worker’ s Compensation and Personal Injury are especially
complex due to the differences in State law and the fact that ICD-10 concepts
have yet to be examined by legal authority. There may be many differences of
opinion about how claims should be coded and/or submitted.
ICD-10 edits are complex and have not been strictly enforced. Therefore, we
are uncertain of how claims will be processed under different circumstances and
with different insurance company policies, or even differences in State laws.
On a positive note, ICD-10 gives the doctor more flexibility regarding injury
and diagnostic coding.
1
2 ◾ Advanced ICD-10 for Physicians
ICD-10
The International Classification of Diseases and Related Health Problems, 10th
Revision, is a coding system developed and maintained by the World Health
Organization. The purpose of this code set is to serve as a tool for the clas-
sification of morbidity data for indexing medical records, medical care review,
as well as a basis for health statistics. ICD-10-CM is the United States’ Clinical
Modification of the World Health Organization’ s ICD-10.
Annual modifications are made to ICD-9-CM and ICD-10-CM by the
Coordination and Maintenance Committee (C&M). The Committee is made up of
representatives from two Federal Government Agencies, the National Center for
Health Statistics and the Centers for Medicare and Medicaid Services. Everyone
who is covered by the Health Insurance and Portability and Accountability
Act (HIPAA) must to use ICD-10 , not just those who submit Medicare and/or
Medicaid claims.
The change in title from “ International Classification of Diseases” to
“ International Classification of Diseases and Related Health Problems” shows that
the scope of the classification has moved beyond the classification of disease and
injuries to the coding of ambulatory care conditions and risk factors frequently
encountered in primary care. Please note that V codes and E codes in ICD-9 are
no longer supplemental, nor optional. They have been modified and incorpo-
rated into the main body of ICD-10 in Chapters 19 and 20.
One of the fundamental goals of ICD-10 is to provide greater Data Granularity.
Granularity means a greater level of detail to support improved clinical outcomes
and more cost-effective disease management.
It also means that providers must document at a level to support the
Granularity. Billing and support staff must have the appropriate level of docu-
mentation in order to meet the increased coding requirements. This includes
proper injury coding for Worker’ s Compensation and Personal Injury.
It is important to understand that the ICD-10 coding system was not designed
with the U.S. Health Care Reimbursement system in mind. This means that many
compatibility issues exist. It is like trying to fit a square peg into a round hole at
certain times when using ICD-10 for billing purposes. We have created a 6 Category
System that helps handle these incompatibilities when dealing with Injury Coding.
Reasons to Avoid Relying on GEM Software

The current viewpoint of many physicians is that the change to ICD-10 is rela-
tively easy because of the existence of General Equivalency Mapping (GEM)
software. There are many published articles that state the same. GEM refers to
software that allows users to enter an ICD-9 code and get a display of an ICD-10
code or codes that can be used in lieu of the ICD-9 code. This is a big mistake ,
especially for Injury Coding.
Chapter One ◾ 3
External Cause codes are used when a patient is injured or adversely

affected by an external cause such as a fall during employment activities. These
codes are in a separate chapter. As an example, using a GEM tool, you may enter
ICD-9 code 722.1— Disc herniation. Using an online crosswalk tool can lead you
to M51.26— Other intervertebral disc displacement, lumbar region. A more appro-
priate code in Worker’ s Compensation might be S33.0— Traumatic rupture of
lumbar intervertebral disc. An example of the complete code is
S33.0XXA Traumatic rupture of lumbar intervertebral disc— Initial

encounter
Excludes 1— Rupture or displacement (nontraumatic) of interverte-
bral disc NOS (M51.-)
Providers must be cognizant that their documentation must support the

code(s) used. They must also know that the use of codes other than External
Cause codes can be interpreted as conditions that are not a result of a work-
related, or accident activity.
External Cause codes may, at a future point in time, require the use of activ-
ity and place of occurrence codes. These specify what the patient was doing to
cause the injury and where the injury occurred. GEM tools do not help in deter-
mining these codes.
Another reason for being cautious about using GEM tools is that the ICD-
10-CM Draft Release is not complete and is still evolving. ICD-10 is being revised
as we speak. You may be able to use a GEM crosswalk today and next week it
will be erroneous.
Chapter 2
Chapter Two
Structural Overview of the ICD-10-CM Book

The ICD-10-CM book is divided into three basic sections:
1. An Introduction with instructions/guidelines

2. Volume 2, which is in four parts
a. Alphabetic Index to Diseases— listed alphabetically by condition (not by
anatomical site)
b. Table for Neoplasms
c. Table of Drugs and Chemicals
d. Alphabetic Index to External Causes of Injury
3. Volume 1— Tabular List of Diseases
Worker’ s Compensation and Personal Injury practices will mainly be working

with many of the subsections due to the wide scope of services.
Please note that Chapter 20 – Volume 1 deals with all external causes of
injury, including poisoning, auto-accidents, falls from horses, and so on.
At first, it can be a bit confusing to navigate through the book ICD-10-CM
Draft Release Expert Edition . Here are some important locations for certain items:
In the “ Alphabetic Index to Diseases,” muscle strains are listed under “ Injury,”
subcategory “ Muscle,” while sprains are listed under “ Sprains.”
Categories S10 to S19 are for injuries to the neck area.
When looking for “ cervical, sprains and strains,” or any other condition of the
neck area, this is where you go.
S20 to S29 is injuries to the thorax area.
When looking for “ thoracic, sprains and strains,” or any other condition of the
thoracic area, this is where you go.
S30 to S39 is injuries to the lumbar area.
When looking for “ lumbar, sprains and strains,” or any other condition of the
lumbar area, this is where you go.
5
Please note that the above codes start with an S, thus indicating a condition
as a result of injury. Similar diagnoses also exist under the M codes, which do not
necessarily imply injury.
Code Structure Basics

ICD-9 codes contain from three to five numeric (N) digits. ICD-10 codes have valid
codes containing three to seven characters (alpha and numeric, A/N, not just digits).
ICD 9 Format ICD-10 Format
N N N . N N A N A/N . A/N A/N A/N A/N
____ ____ ____ . ____ ____ ____ ____ ____ . ____ ____ ____ ____
The first character in ICD-10 is always a letter. The second is always a num-
ber. The third character can be alpha or numeric. There is a period after the third
character if there are more than three characters. Characters after the first three can
be alpha or numeric. If a code requiring a seventh character is not six characters in
length, then a placeholder, X, must be used to fill the empty character fields.
For example, S33.8XXA— Sprain of other parts of lumbar spine and pel-
vis— Active Care:
The first character can use any letter with the exception of U, which is cur-
rently not used, but may be in the future. The use of an alpha character means
that there can be up to 26 characters instead of just 10 when using numeric
codes.
ICD-9 and ICD-10 both have a Table of Contents. In ICD-9, the Table shows a
Tabular List of 17 diseases and two supplemental classifications: V codes and E
codes.
In ICD-10, there are 21 disease classifications listed, which incorporate ICD-9
V codes and E codes. “ External caused injuries” and “ external causes of morbid-
ity” (ICD-9 E codes) are concentrated in Chapters 19 and 20 in ICD-10. Factors
Influencing Health Status (ICD-9 V codes) are concentrated in Chapter 20.
Using ICD-10 Overview

Billers and coders would use ICD-10 in a manner similar to using ICD-9. You
would look in the Table of Contents for the major category. You can also use the
Alphabetic Index to determine specific codes.
The major obstacle for billers and coders are as follows:
1. Many ICD-9 codes do not have a one-to-one crosswalk to ICD-10. Many

codes have multiple possible choices.
Chapter Two ◾ 7
2. There are over 400 instances where a single ICD-9 code can map to more
than 50 ICD-10 codes.*
3. There are over 200 instances where a single ICD-9 code can map to more
than 100 ICD-10 codes.*
4. ICD-10 represents an increase of over 700% in the number of codes versus
ICD-9.
5. Medical records may not contain the necessary information to properly
choose the correct ICD-10 code(s).
Note: *These statistics were published by the CMS, April 2013 in an article
"General Equivalence Mapping Frequently Asked Questions."
Example in coding:
ICD-9 Description
846.0 Lumbosacral (Joint) (Ligament) Sprain
Reviewing the Alphabetic Index in ICD-10, we find:

ICD-10 Description
S33.9 Sprain, lumbosacral
The ICD-10 Alphabetic Index directs you to an S code. S codes are used for
Injury, Poisoning and Certain Other Consequences of External Causes. In effect,
you are directed to the ICD-9 equivalent of an E code.
It should be noted that ICD-10 has a separate Alphabetic Index to External
Causes. A review of this index shows that there are no direct references to S
codes. Rather, you are directed to the circumstances of an accident (for example,
a motorcycle collision), which are specified by Y and V codes, which further
describe the circumstances of the injury.
Whenever an S code is assigned, you should also have an external cause of
morbidity ‘Y’ code, which are found in Chapter 20.
The lack of a one-to-one relationship should be a red flag that using a simple
crosswalk tool will not allow you to understand ICD-10.
Chapter 3
Chapter Three
Components of ICD-10 and Their Usage

ICD-10 is basically an update of ICD-9. Many of the features of ICD-9 appear in
ICD-10.
Both have an Alphabetic Index to Disease and a Tabular List of Diseases,
which are used in a similar manner.
The major differences are that, in ICD-9, the Tabular Index contains 17 cat-
egories of diseases, which are numerically identified, and two categories of
Supplemental Classifications (V and E codes). In ICD-10, the Tabular List includes
21 categories, including two for External Causes and one for Factors Influencing
Health Status and Contact with Health Service.
E codes in ICD-9 become Y, W, and X codes in ICD-10. V codes in ICD-9
become Z codes in ICD-10. ICD-9 codes have three to five numeric digits while
ICD-10 codes have three to seven alpha-numeric characters from A00- to Z99-.
The first three characters in ICD-10 are essential subdivisions of the disease
classification, for example, “ R10 Abdominal and Pelvic Pain” . Four-character sub-
categories are subdivisions of three-character categories and define their Axis of
Classification.
Axis of Classification refers to how disease can be arranged in ICD-10.
They can be arranged by etiology (cause), anatomy, or severity.
Anatomy is the primary Axis of Classification, and the most commonly used.
For example:
R10.1 Pain localized in the upper abdomen
Then, further classification is noted in the fifth character.
R10.10 Upper abdominal pain, unspecified

R10.11 Right upper quadrant pain
R10.12 Left upper quadrant pain
R10.13 Epigastric pain
9
Severity is another Axis of Classification.

For example:
G44.0 Cluster headaches and other trigeminal autonomic cephalgias (TAC)

G44.201 Tension-type headache, unspecified intractable
G44.209 Tension-type headache, unspecified, not intractable
It is important that the doctor indicates the severity of the condition, as office
staff may need this information in order to properly code and bill.
Etiology (cause) is the final Axis of Classification.

For example:
G44.5 Complicated headache syndromes

G44.51 Hemicrania continua
G44.52 New daily persistent headache (NDI)
G44.53 Primary thunderclap headache
G44.59 Other complicated headache syndrome
For cases where the doctor is uncertain of the specificity of the Axis of
Classification, the ICD-10 uses the fourth character to state this. An 8 is used to
signify “ other specified,” and 9 is used to signify “ unspecified.”
For example:
R10 Abdominal and pelvic pain

R10.8 Other abdominal pain
R10.9 Unspecified abdominal pain
Five- and six-character subdivisions are used as follows:

The fifth character can be used to provide a second Axis of Classification.
For example:
R10.81 Abdominal tenderness

R10.82 Rebound abdominal tenderness
The sixth characters can be used to further subdivide fifth-character classifica-

tions for greater specificity.
For example, anatomical location:
R10.811 Right upper quadrant abdominal tenderness

R10.812 Left upper quadrant abdominal tenderness
R10.813 Right lower quadrant abdominal tenderness
R10.814 Left lower quadrant abdominal tenderness
Another random document with
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THE FREEBOOTER OF LOCHABER.
By Sir Thomas Dick Lauder.
Towards the end of the seventeenth century, there lived a certain

notorious freebooter, in the county of Moray, a native of Lochaber, of
the name of Cameron, but who was better known by his cognomen of
Padrig Mac-an-Ts’agairt, which signifies, “Peter, the Priest’s Son.”
Numerous were the “creachs,” or robberies of cattle on a great scale,
driven by him from Strathspey. But he did not confine his
depredations to that country; for, some time between the years 1690
and 1695, he made a clean sweep of the cattle from the rich pastures
of the Aird, the territory of the Frasers. That he might put his
pursuers on a wrong scent, he did not go directly towards Lochaber,
but, crossing the river Ness at Lochend, he struck over the mountains
of Strathnairn and Strathdearn, and ultimately encamped behind a
hill above Duthel, called, from a copious spring on its summit, Cairn-
an-Sh’uaran, or the Well Hill. But, notwithstanding all his
precautions, the celebrated Simon Lord Lovat, then chief of the
Frasers, discovered his track, and despatched a special messenger to
his father-in-law, Sir Ludovick Grant of Grant, begging his aid in
apprehending Mac-an-Ts’agairt, and recovering the cattle.
It so happened that there lived at this time, on the laird of Grant’s
ground, a man also called Cameron, surnamed Mugach More, of
great strength and undaunted courage; he had six sons and a
stepson, whom his wife, formerly a woman of light character, had
before her marriage with Mugach, and, as they were all brave, Sir
Ludovick applied to them to undertake the recapture of the cattle. Sir
Ludovic was not mistaken in the man. The Mugach no sooner
received his orders, than he armed himself and his little band, and
went in quest of the freebooter, whom he found in the act of cooking
a dinner from part of the spoil. The Mugach called on Padrig and his
men to surrender, and they, though numerous, dreading the well-
known prowess of their adversary, fled to the opposite hills, their
chief threatening bloody vengeance as he went. The Mugach drove
the cattle to a place of safety, and watched them till their owners
came to recover them.
Padrig did not utter his threats without the fullest intention of
carrying them into effect. In the latter end of the following spring, he
visited Strathspey with a strong party, and waylaid the Mugach, as he
and his sons were returning from working at a small patch of land he
had on the brow of a hill, about half-a-mile above his house. Padrig
and his party concealed themselves in a thick covert of underwood,
through which they knew that the Mugach and his sons must pass;
but seeing their intended victims well-armed, the cowardly assassins
lay still in their hiding-place, and allowed them to pass, with the
intention of taking a more favourable opportunity for their purpose.
That very night they surprised and murdered two of the sons, who,
being married, lived in separate houses, at some distance from their
father’s; and, having thus executed so much of their diabolical
purpose, they surrounded the Mugach’s cottage.
No sooner was his dwelling attacked, than the brave Mugach,
immediately guessing who the assailants were, made the best
arrangements for defence that time and circumstances permitted.
The door was the first point attempted; but it was strong, and he and
his four sons placed themselves behind it, determined to do bloody
execution the moment it should be forced. Whilst thus engaged, the
Mugach was startled by a noise above the rafters, and, looking up, he
perceived, in the obscurity, the figure of a man half through a hole in
the wattled roof. Eager to despatch his foe as he entered, he sprang
upon a table, plunged his sword into his body, and down fell—his
stepson, whom he had ever loved and cherished as one of his own
children! The youth had been cutting his way through the roof, with
the intention of attacking Padrig from above, and so creating a
diversion in favour of those who were defending the door. The brave
young man lived no longer than to say, “Dear father, I fear you have
killed me!”
For a moment the Mugach stood petrified with horror and grief,
but rage soon usurped the place of both. “Let me open the door!” he
cried, “and revenge his death, by drenching my sword in the blood of
the villain!” His sons clung around him, to prevent what they
conceived to be madness, and a strong struggle ensued between
desperate bravery and filial duty; whilst the Mugach’s wife stood
gazing on the corpse of her first-born son, in an agony of contending
passions, being ignorant from all she had witnessed but that the
young man’s death had been wilfully wrought by her husband. “Hast
thou forgotten our former days?” cried the wily Padrig, who saw the
whole scene through a crevice in the door. “How often hast thou
undone thy door to me, and wilt thou not open it now, to give me
way to punish him who has, but this moment, so foully slain thy
beloved son?” Ancient recollections, and present affliction, conspired
to twist her to his purpose. The struggle and altercation between the
Mugach and his sons still continued. A frenzy seized on the unhappy
woman; she flew to the door, undid the bolt, and Padrig and his
assassins rushed in.
The infuriated Mugach no sooner beheld his enemy enter, than he
sprang at him like a tiger, grasped him by the throat, and dashed him
to the ground. Already was his vigorous sword-arm drawn back, and
his broad claymore was about to find a passage to the traitor’s heart,
when his faithless wife, coming behind him, threw over it a large
canvas winnowing-sheet, and, before he could extricate the blade
from the numerous folds, Padrig’s weapon was reeking in the best
heart’s-blood of the bravest Highlander that Strathspey could boast
of. His four sons, who had witnessed their mother’s treachery, were
paralyzed. The unfortunate woman herself, too, stood stupified and
appalled. But she was quickly recalled to her senses by the active
clash of the swords of Padrig and his men. “Oh, my sons, my sons!”
she cried; “spare my boys!” But the tempter needed her services no
longer,—she had done his work. She was spurned to the ground and
trampled under foot by those who soon strewed the bloody floor
around her with the lifeless corpses of her brave sons.
Exulting in the full success of this expedition of vengeance, Mac-
an-Ts’agairt beheaded the bodies, and piled the heads in a heap on
an oblong hill that runs parallel to the road on the east side of Carr
Bridge, from which it is called Tom-nan-Cean, the Hill of the Heads.
Scarcely was he beyond the reach of danger, than his butchery was
known at the Castle Grant, and Sir Ludovick immediately offered a
great reward for his apprehension; but Padrig, who had anticipated
some such thing, fled to Ireland, where he remained for seven years.
But the restlessness of the murderer is well known, and Padrig felt it
in all its horrors. Leaving his Irish retreat, he returned to Lochaber.
By a strange accident, a certain Mungo Grant, of Muckrach, having
had his cattle and horses carried away by some thieves from that
quarter, pursued them hot foot, recovered them, and was on his way
returning with them, when, to his astonishment, he met Padrig Mac-
an-Ts’agairt, quite alone in a narrow pass, on the borders of his
native country. Mungo instantly seized and made a prisoner of him.
But his progress with his beasts was tedious; and as he was entering
Strathspey at Lag-na-caillich, about a mile to the westward of
Aviemore, he espied twelve desperate men, who, taking advantage of
his slow march, had crossed the hills to gain the pass before him, for
the purpose of rescuing Padrig. But Mungo was not to be daunted.
Seeing them occupying the road in his front, he grasped his prisoner
with one hand, and brandishing his dirk with the other, he advanced
in the midst of his people and animals, swearing potently that the
first motion at an attempt at rescue by any one of them should be the
signal for his dirk to drink the life’s-blood of Padrig Mac-an-
Ts’agairt. They were so intimidated by his boldness that they allowed
him to pass without assault, and left their friend to his fate. Padrig
was forthwith carried to Castle Grant. But the remembrance of the
Mugach’s murder had been by this time much obliterated by many
events little less strange, and the laird, unwilling to be troubled with
the matter, ordered Mungo and his prisoner away.
Disappointed and mortified, Mungo and his party were returning
with their captive, discussing, as they went, what they had best do
with him. “A fine reward we have had for all our trouble!” said one.
“The laird may catch the next thief her nainsel, for Donald!” said
another. “Let’s turn him loose!” said a third. “Ay, ay,” said a fourth;
“what for wud we be plaguing oursels more wi’ him?” “Yes, yes!
brave, generous men!” said Padrig, roused by a sudden hope of life
from the moody dream of the gallows-tree in which he had been
plunged, whilst he was courting his mournful muse to compose his
own lament, that he might die with an effect striking, as all the
events of his life had been. “Yes, brave men, free me from these
bonds! It is unworthy of Strathspey men,—it is unworthy of Grants to
triumph over a fallen foe! Those whom I killed were no clansmen of
yours, but recreant Camerons, who betrayed a Cameron! Let me go
free, and that reward of which you have been disappointed shall be
quadrupled for sparing my life.” Such words as these, operating on
minds so much prepared to receive them favourably, had well-nigh
worked their purpose. But “No!” said Muckrach sternly, “it shall
never be said that a murderer escaped from my hands. Besides, it
was just so that he fairly spake the Mugach’s false wife. But did he
spare her sons on that account? If ye let him go, my men, the fate of
the Mugach may be ours; for what bravery can stand against
treachery and assassination?” This opened an entirely new view of
the question to Padrig’s rude guards, and the result of the conference
was that they resolved to take him to Inverness, and to deliver him
up to the sheriff.
As they were pursuing their way up the south side of the river
Dulnan, the hill of Tom-nan-Cean appeared on that opposite to
them. At sight of it the whole circumstances of Padrig’s atrocious
deed came fresh in to their minds. It seemed to cry on them for
justice, and with one impulse they shouted out, “Let him die on the
spot where he did the bloody act!” Without a moment’s farther delay,
they determined to execute their new resolution. But on their way
across the plain, they happened to observe a large fir tree, with a
thick horizontal branch growing at right angles from the trunk, and
of a sufficient height from the ground to suit their purpose; and
doubting if they might find so convenient a gallows where they were
going, they at once determined that here Padrig should finish his
mortal career. The neighbouring birch thicket supplied them with
materials for making a withe; and whilst they were twisting it, Padrig
burst forth in a flood of Gaelic verse, which his mind had been
accumulating by the way. His song and the twig rope that was to
terminate his existence were spun out and finished at the same
moment, and he was instantly elevated to a height equally beyond his
ambition and his hopes.
AN HOUR IN THE MANSE.
By Professor Wilson.
In a few weeks the annual sacrament of the Lord’s Supper was to

be administered in the parish of Deanside; and the minister,
venerable in old age, of authority by the power of his talents and
learning, almost feared for his sanctity, yet withal beloved for
gentleness and compassion that had never been found wanting,
when required either by the misfortunes or errors of any of his flock,
had delivered for several successive Sabbaths, to full congregations,
sermons on the proper preparation of communicants in that awful
ordinance. The old man was a follower of Calvin; and many, who had
listened to him with a resolution in their hearts to approach the table
of the Redeemer, felt so awe-stricken and awakened at the
conclusion of his exhortations, that they gave their souls another
year to meditate on what they had heard, and by a pure and humble
course of life, to render themselves less unworthy to partake the
mysterious and holy bread and wine.
The good old man received in the manse, for a couple of hours
every evening, such of his parishioners as came to signify their wish
to partake of the sacrament; and it was then noted, that, though he in
nowise departed, in his conversation with them at such times, from
the spirit of those doctrines which he had delivered from the pulpit,
yet his manner was milder, and more soothing, and full of
encouragement; so that many who went to him almost with quaking
hearts, departed in tranquillity and peace, and looked forward to that
most impressive and solemn act of the Christian faith with calm and
glad anticipation. The old man thought, truly and justly, that few, if
any, would come to the manse, after having heard him in the kirk,
without due and deep reflection; and therefore, though he allowed
none to pass through his hands without strict examination, he spoke
to them all benignly, and with that sort of paternal pity which a
religious man, about to leave this life, feels towards all his brethren
of mankind, who are entering upon, or engaged in, its scenes of
agitation, trouble, and danger.
On one of those evenings, the servant showed into the minister’s
study a tall, bold-looking, dark-visaged man, in the prime of life,
who, with little of the usual courtesy, advanced into the middle of the
room, and somewhat abruptly declared the sacred purpose of his
visit. But before he could receive a reply, he looked around and
before him; and there was something so solemn in the old minister’s
appearance, as he sat like a spirit, with his unclouded eyes fixed upon
the intruder, that that person’s countenance fell, and his heart was
involuntarily knocking against his side. An old large Bible, the same
that he read from in the pulpit, was lying open before him. One
glimmering candle showed his beautiful and silvery locks falling over
his temples, as his head half stooped over the sacred page; a dead
silence was in the room dedicated to meditation and prayer; the old
man, it was known, had for some time felt himself to be dying, and
had spoken of the sacrament of this summer as the last he could ever
hope to administer; so that altogether, in the silence, the dimness,
the sanctity, the unworldliness of the time, the place, and the being
before him, the visitor stood like one abashed and appalled; and
bowing more reverently, or at least respectfully, he said, with a
quivering voice, “Sir, I come for your sanction to be admitted to the
table of our Lord.”
The minister motioned to him with his hand to sit down; and it
was a relief to the trembling man to do so, for he was in the presence
of one who, he felt, saw into his heart. A sudden change from
hardihood to terror took place within his dark nature; he wished
himself out of the insupportable sanctity of that breathless room;
and a remorse, that had hitherto slept, or been drowned within him,
now clutched his heartstrings, as if with an alternate grasp of frost
and fire, and made his knees knock against each other where he sat,
and his face pale as ashes.
“Norman Adams, saidst thou that thou wilt take into that hand,
and put into those lips, the symbol of the blood that was shed for
sinners, and of the body that bowed on the cross, and then gave up
the ghost? If so, let us speak together, even as if thou wert
communing with thine own heart. Never again may I join in that
sacrament, for the hour of my departure is at hand. Say, wilt thou eat
and drink death to thine immortal soul?”
The terrified man found strength to rise from his seat, and,
staggering towards the door, said, “Pardon, forgive me!—I am not
worthy.”
“It is not I who can pardon, Norman. That power lies not with
man; but sit down—you are deadly pale—and though, I fear, an ill-
living and a dissolute man, greater sinners have repented and been
saved. Approach not now the table of the Lord, but confess all your
sins before Him in the silence of your own house, and upon your
naked knees on the stone-floor every morning and every night; and if
this you do faithfully, humbly, and with a contrite heart, come to me
again when the sacrament is over, and I will speak words of comfort
to you (if then I am able to speak)—if, Norman, it should be on my
deathbed. This will I do for the sake of thy soul, and for the sake of
thy father, Norman, whom my soul loved, and who was a support to
me in my ministry for many long, long years, even for two score and
ten, for we were at school together; and had your father been living
now, he would, like myself, have this very day finished his eighty-
fifth year. I send you not from me in anger, but in pity and love. Go,
my son, and this very night begin your repentance, for if that face
speak the truth, your heart must be sorely charged.”
Just as the old man ceased speaking, and before the humble, or at
least affrighted culprit had risen to go, another visitor of a very
different kind was shown into the room—a young, beautiful girl,
almost shrouded in her cloak, with a sweet pale face, on which
sadness seemed in vain to strive with the natural expression of the
happiness of youth.
“Mary Simpson,” said the kind old man, as she stood with a timid
courtesy near the door, “Mary Simpson, approach, and receive from
my hands the token for which thou comest. Well dost thou know the
history of thy Saviour’s life, and rejoicest in the life and immortality
brought to light by the gospel. Young and guileless, Mary, art thou;
and dim as my memory now is of many things, yet do I well
remember the evening, when first beside my knee, thou heardst read
how the Divine Infant was laid in a manger, how the wise men from
the East came to the place of His nativity, and how the angels were
heard singing in the fields of Bethlehem all the night long.”
Alas! every word that had thus been uttered sent a pang into the
poor creature’s heart, and, without lifting her eyes from the floor,
and in a voice more faint and hollow than belonged to one so young,
she said, “O sir! I come not as an intending communicant; yet the
Lord my God knows that I am rather miserable than guilty, and He
will not suffer my soul to perish, though a baby is now within me, the
child of guilt, and sin, and horror. This, my shame, come I to tell you;
but for the father of my babe unborn, cruel though he has been to
me,—oh! cruel, cruel, indeed,—yet shall his name go down with me
in silence to the grave. I must not, must not breathe his name in
mortal ears; but I have looked round me in the wide moor, and when
nothing that could understand was by, nothing living but birds, and
bees, and the sheep I was herding, often have I whispered his name
in my prayers, and beseeched God and Jesus to forgive him all his
sins.”
At these words, of which the passionate utterance seemed to
relieve her heart, and before the pitying and bewildered old man
could reply, Mary Simpson raised her eyes from the floor, and
fearing to meet the face of the minister, which had heretofore never
shone upon her but with smiles, and of which the expected frown
was to her altogether insupportable, she turned them wildly round
the room, as if for a dark resting-place, and beheld Norman Adams
rooted to his seat, leaning towards her with his white, ghastly
countenance, and his eyes starting from their sockets, seemingly in
wrath, agony, fear, and remorse. That terrible face struck poor Mary
to the heart, and she sank against the wall, and slipped down,
shuddering, upon a chair.
“Norman Adams, I am old and weak, but do you put your arm
round that poor lost creature, and keep her from falling down on the
hard floor. I hear it is a stormy night, and she has walked some miles
hither; no wonder she is overcome. You have heard her confession,
but it was not meant for your ear; so, till I see you again, say nothing
of what you have now heard.”
“O sir! a cup of water, for my blood is either leaving my heart
altogether, or it is drowning it. Your voice, sir, is going far, far away
from me, and I am sinking down. Oh, hold me!—hold me up! Is it a
pit into which I am falling?—Saw I not Norman Adams?—Where is
he now?”
The poor maiden did not fall off the chair, although Norman
Adams supported her not; but her head lay back against the wall, and
a sigh, long and dismal, burst from her bosom, that deeply affected
the old man’s heart, but struck that of the speechless and motionless
sinner, like the first toll of the prison bell that warns the felon to
leave his cell and come forth to execution.
The minister fixed a stern eye upon Norman, for, from the poor
girl’s unconscious words, it was plain that he was the guilty wretch
who had wrought all this misery. “You knew, did you not, that she
had neither father nor mother, sister nor brother, scarcely one
relation on earth to care for or watch over her; and yet you have used
her so? If her beauty was a temptation unto you, did not the sweet
child’s innocence touch your hard and selfish heart with pity? or her
guilt and grief must surely now wring it with remorse. Look on her—
white, cold, breathless, still as a corpse; and yet, thou bold bad man,
thy footsteps would have approached the table of thy Lord!”
The child now partly awoke from her swoon, and her dim opening
eyes met those of Norman Adams. She shut them with a shudder,
and said, sickly and with a quivering voice, “Oh spare, spare me,
Norman! Are we again in that dark, fearful wood? Tremble not for
your life on earth, Norman, for never, never will I tell to mortal ears
that terrible secret; but spare me, spare me, else our Saviour, with all
His mercy, will never pardon your unrelenting soul. These are cruel-
looking eyes; you will not surely murder poor Mary Simpson,
unhappy as she is, and must for ever be—yet life is sweet! She
beseeches you on her knees to spare her life!”—and, in the intense
fear of phantasy, the poor creature struggled off the chair, and fell
down indeed in a heap at his feet.
“Canst thou indeed be the son of old Norman Adams, the
industrious, the temperate, the mild, and the pious—who so often sat
in this very room which thy presence has now polluted, and spake
with me on the mysteries of life and of death? Foul ravisher, what
stayed thy hand from the murder of that child, when there were none
near to hear her shrieks in the dark solitude of the great pine-wood?”
Norman Adams smote his heart and fell down too on his knees
beside the poor ruined orphan. He put his arm round her, and,
raising her from the floor, said, “No, no, my sin is great, too great for
Heaven’s forgiveness; but, oh sir! say not—say not that I would have
murdered her; for, savage as my crime was, yet may God judge me
less terribly than if I had taken her life.”
In a little while they were both seated with some composure, and
silence was in the room. No one spoke, and the old grayhaired man
sat with his eyes fixed, without reading, on the open Bible. At last he
broke silence with these words out of Isaiah, that seemed to have
forced themselves on his heedless eyes:—“Though your sins be as
scarlet, they shall be as white as snow: though they be red like
crimson, they shall be as wool.”
Mary Simpson wept aloud at these words, and seemed to forget
her own wrongs and grief in commiseration of the agonies of
remorse and fear that were now plainly preying on the soul of the
guilty man. “I forgive you, Norman, and will soon be out of the way,
no longer to anger you with the sight of me.” Then, fixing her
streaming eyes on the minister, she besought him not to be the
means of bringing him to punishment and a shameful death, for that
he might repent, and live to be a good man and respected in the
parish; but that she was a poor orphan for whom few cared, and who,
when dead, would have but a small funeral.
“I will deliver myself up into the hands of justice,” said the
offender, “for I do not deserve to live. Mine was an inhuman crime,
and let a violent and shameful death be my doom.”
The orphan girl now stood up as if her strength had been restored,
and stretching out her hands passionately, with a flow of most
affecting and beautiful language, inspired by a meek, single, and
sinless heart that could not bear the thought of utter degradation and
wretchedness befalling any one of the rational children of God,
implored and beseeched the old man to comfort the sinner before
them, and promise that the dark transaction of guilt should never
leave the concealment of their own three hearts. “Did he not save the
lives of two brothers once who were drowning in that black mossy
loch, when their own kindred, at work among the hay, feared the
deep sullen water, and all stood aloof shuddering and shaking, till
Norman Adams leapt in to their rescue, and drew them by the
dripping hair to the shore, and then lay down beside them on the
heather as like to death as themselves? I myself saw it done; I myself
heard their mother call down the blessing of God on Norman’s head,
and then all the haymakers knelt down and prayed. When you, on
the Sabbath, returned thanks to God for that they were saved, oh!
kind sir, did you not name, in the full kirk, him who, under
Providence, did deliver them from death, and who, you said, had
thus showed himself to be a Christian indeed? May his sin against
me be forgotten, for the sake of those two drowning boys, and their
mother, who blesses his name unto this day.”
From a few questions solemnly asked, and solemnly answered, the
minister found that Norman Adams had been won by the beauty and
loveliness of this poor orphan shepherdess, as he had sometimes
spoken to her when sitting on the hill-side with her flock, but that
pride had prevented him from ever thinking of her in marriage. It
appeared that he had also been falsely informed, by a youth whom
Mary disliked for his brutal and gross manners, that she was not the
innocent girl that her seeming simplicity denoted. On returning from
a festive meeting, where this abject person had made many mean
insinuations against her virtue, Norman Adams met her returning to
her master’s house, in the dusk of the evening, on the footpath
leading through a lonely wood; and, though his crime was of the
deepest dye, it seemed to the minister of the religion of mercy, that
by repentance, and belief in the atonement that had once been made
for sinners, he, too, might perhaps hope for forgiveness at the throne
of God.
“I warned you, miserable man, of the fatal nature of sin, when first
it brought a trouble over your countenance, and broke in upon the
peaceful integrity of your life. Was not the silence of the night often
terrible to you, when you were alone in the moors, and the whisper of
your own conscience told you, that every wicked thought was
sacrilege to your father’s dust? Step by step, and almost
imperceptibly, perhaps, did you advance upon the road that leadeth
to destruction; but look back now, and what a long dark journey have
you taken, standing, as you are, on the brink of everlasting death!
Once you were kind, gentle, generous, manly, and free; but you
trusted to the deceitfulness of your own heart; you estranged yourself
from the house of the God of your fathers; and what has your nature
done for you at last, but sunk you into a wretch—savage, selfish,
cruel, cowardly, and in good truth a slave? A felon are you, and
forfeited to the hangman’s hands. Look on that poor innocent child,
and think what is man without God. What would you give now, if the
last three years of your reckless life had been passed in a dungeon
dug deep into the earth, with hunger and thirst gnawing at your
heart, and bent down under a cartload of chains? Yet look not so
ghastly, for I condemn you not utterly; nor, though I know your guilt,
can I know what good may yet be left uncorrupted and
unextinguished in your soul. Kneel not to me, Norman; fasten not so
your eyes upon me; lift them upwards, and then turn them in upon
your own heart, for the dreadful reckoning is between it and God.”
Mary Simpson had now recovered all her strength, and she knelt
down by the side of the groaner. Deep was the pity she now felt for
him, who to her had shown no pity; she did not refuse to lay her light
arm tenderly upon his neck. Often had she prayed to God to save his
soul, even among her rueful sobs of shame in the solitary glens; and
now that she beheld his sin punished with a remorse more than he
could bear, the orphan would have willingly died to avert from his
prostrate head the wrath of the Almighty.
The old man wept at the sight of so much innocence, and so much
guilt, kneeling together before God, in strange union and fellowship
of a common being. With his own fatherly arms he lifted up the
orphan from her knees, and said, “Mary Simpson, my sweet and
innocent Mary Simpson, for innocent thou art, the elders will give
thee a token, that will, on Sabbath-day, admit thee (not for the first
time, though so young) to the communion-table. Fear not to
approach it; look at me, and on my face, when I bless the elements,
and be thou strong in the strength of the Lord. Norman Adams,
return to your home. Go into the chamber where your father died.
Let your knees wear out the part of the floor on which he kneeled. It
is somewhat worn already; you have seen the mark of your father’s
knees. Who knows, but that pardon and peace may descend from
Heaven upon such a sinner as thou? On none such as thou have mine
eyes ever looked, in knowledge, among all those who have lived and
died under my care, for three generations. But great is the unknown
guilt that may be hidden even in the churchyard of a small quiet
parish like this. Dost thou feel as if God-forsaken? Or, oh! say it unto
me, canst thou, my poor son, dare to hope for repentance?”
The pitiful tone of the old man’s trembling voice, and the motion
of his shaking and withered hands, as he lifted them up almost in an
attitude of benediction, completed the prostration of that sinner’s
spirit. All his better nature, which had too long been oppressed under
scorn of holy ordinances, and the coldness of infidelity, and the
selfishness of lawless desires that insensibly harden the heart they do
not dissolve, now struggled to rise up and respect its rights. “When I
remember what I once was, I can hope—when I think what I now am,
I only, only fear.”
A storm of rain and wind had come on, and Mary Simpson slept in
the manse that night. On the ensuing Sabbath she partook of the
sacrament. A woeful illness fell upon Norman Adams; and then for a
long time no one saw him, or knew where he had gone. It was said
that he was in a distant city, and that he was a miserable creature,
that never again could look upon the sun. But it was otherwise
ordered. He returned to his farm, greatly changed in face and person,
but even yet more changed in spirit.
The old minister had more days allotted to him than he had
thought, and was not taken away for some summers. Before he died,
he had reason to know that Norman Adams had repented in tears of
blood, in thoughts of faith, and in deeds of charity; and he did not
fear to admit him, too, in good time, to the holy ordinance, along
with Mary Simpson, then his wife, and the mother of his children.
THE WARDEN OF THE MARCHES:
A TRADITIONARY STORY OF ANNANDALE.
The predatory incursions of the Scots and English borderers, on

each other’s territories, are known to every one in the least
acquainted with either the written or traditional history of his
country. These were sometimes made by armed and numerous
bodies, and it was not uncommon for a band of marauders to take
advantage of a thick fog or a dark night for plundering or driving
away the cattle, with which they soon escaped over the border, where
they were generally secure. Such incursions were so frequent and
distressing to the peaceable and well-disposed inhabitants that they
complained loudly to their respective governments; in consequence
of which some one of the powerful nobles residing on the borders
was invested with authority to suppress these depredations, under
the title of Warden of the Marches. His duty was to protect the
frontier, and alarm the country by firing the beacons which were
placed on the heights, where they could be seen at a great distance,
as a warning to the people to drive away their cattle, and, collecting
in a body, either to repel or pursue the invaders, as circumstances
might require. The wardens also possessed a discretionary power in
such matters as came under their jurisdiction. The proper discharge
of this important trust required vigilance, courage, and fidelity, but it
was sometimes committed to improper hands, and consequently the
duty was very improperly performed.
In the reign of James V. one of these wardens was Sir John
Charteris of Amisfield, near Dumfries, a brave but haughty man, who
sometimes forgot his important trust so far as to sacrifice his public
duties to his private interests.
George Maxwell was a young and respectable farmer in
Annandale, who had frequently been active in repressing the petty
incursions to which that quarter of the country was exposed. Having
thereby rendered himself particularly obnoxious to the English
borderers, a strong party was formed, which succeeded in despoiling
him, by plundering his house and driving away his whole live stock.
At the head of a large party he pursued and overtook the “spoil-
encumbered foe;” a fierce and bloody contest ensued, in which
George fell the victim of a former feud, leaving his widow, Marion, in
poverty, with her son Wallace, an only child in the tenth year of his
age. By the liberality of her neighbours, the widow was replaced in a
small farm; but by subsequent incursions she was reduced to such
poverty that she occupied a small cottage, with a cow, which the
kindness of a neighbouring farmer permitted to pasture on his fields.
This, with the industry and filial affection of her son, now in his
twentieth year, enabled her to live with a degree of comfort and
contented resignation.
With a manly and athletic form, Wallace Maxwell inherited the
courage of his father, and the patriotic ardour of the chieftain after
whom he had been named; and Wallace had been heard to declare,
that although he could not expect to free his country from the
incursions of the English borderers, he trusted he should yet be able
to take ample vengeance for the untimely death of his father.
But although his own private wrongs and those of his country had
a powerful influence on the mind of Wallace Maxwell, yet his heart
was susceptible of a far loftier passion.
His fine manly form and graceful bearing had attractions for many
a rural fair; and he would have found no difficulty in matching with
youthful beauty considerably above his own humble station. But his
affections were fixed on Mary Morrison, a maiden as poor in worldly
wealth as himself; but nature had been more than usually indulgent
to her in a handsome person and fine features; and, what was of
infinitely more value, her heart was imbued with virtuous principles,
and her mind better cultivated than could have been expected from
her station in life. To these accomplishments were superadded a
native dignity, tempered with modesty, and a most winning
sweetness of manner. Mary was the daughter of a man who had seen
better days; but he was ruined by the incursions of the English
borderers; and both he and her mother dying soon after, Mary was
left a helpless orphan in the twentieth year of her age. Her beauty
procured her many admirers; and her unprotected state (for she had
no relations in Annandale) left her exposed to the insidious
temptations of unprincipled villainy; but they soon discovered that
neither flattery, bribes, nor the fairest promises, had the slightest
influence on her spotless mind. There were many, however, who
sincerely loved her, and made most honourable proposals; among
whom was Wallace Maxwell, perhaps the poorest of her admirers,
but who succeeded in gaining her esteem and affection. Mary and he
were fellow-servants to the farmer from whom his mother had her
cottage; and, on account of the troublesome state of the country,
Wallace slept every night in his mother’s house as her guardian and
protector. Mary and he were about the same age, both in the bloom
of youthful beauty; but both had discrimination to look beyond
external attractions; and, although they might be said to live in the
light of each other’s eyes, reason convinced them that the time was
yet distant when it would be prudent to consummate that union
which was the dearest object of their wishes.
A foray had been made by the English, in which their leader, the
son of a rich borderer, had been made prisoner, and a heavy ransom
paid to Sir John, the warden, for his release. This the avaricious
warden considered a perquisite of his office; and it accordingly went
into his private pocket. Soon after this, the party who had resolved
on ruining Wallace Maxwell for his threats of vengeance, took
advantage of a thick fog during the day, succeeded by a dark night, in
making an incursion on Annandale, principally for the purpose of
capturing the young man. By stratagem they effected their purpose;
and the widow’s cow, and Wallace her son, were both carried off as
part of the spoil. The youth’s life might have been in considerable
danger, had his capture not been discovered by the man who had
recently paid a high ransom for his own son, and he now took instant
possession of Wallace, resolving that he should be kept a close
prisoner till ransomed by a sum equal to that paid to the warden.
It would be difficult, if not impossible, to say whether the grief of
Widow Maxwell for her son, or that of Mary Morrison for her lover,
was greatest. But early in the ensuing morning the widow repaired to
Amisfield, related the circumstance to Sir John, with tears
beseeching him, as the plunderers were not yet far distant, to
despatch his forces after them, and rescue her son, with the property
of which she had been despoiled, for they had carried off everything,
even to her bed-clothes.
Wallace Maxwell had some time before incurred the warden’s
displeasure, whose mind was not generous enough either to forget or
forgive. He treated Marion with an indifference approaching almost
to contempt, by telling her that it would be exceedingly improper to
alarm the country about such a trivial incident, to which every
person in that quarter was exposed; and although she kneeled to
him, he refused to comply with her request, and proudly turned
away.
With a heavy and an aching heart, the widow called on Mary
Morrison on her way home to her desolate dwelling, relating the
failure of her application, and uttering direful lamentations for the
loss of her son; all of which were echoed by the no less desponding
maiden.
In the anguish of her distress, Mary formed the resolution of
waiting on the warden, and again urging the petition which had
already been so rudely rejected. Almost frantic, she hastened to the
castle, demanding to see Sir John. Her person was known to the
porter, and he was also now acquainted with the cause of her present
distress; she therefore found a ready admission. Always beautiful,
the wildness of her air, the liquid fire which beamed in her eyes, from
which tears streamed over her glowing cheeks, and the perturbation
which heaved her swelling bosom, rendered her an object of more
than ordinary interest in the sight of the warden. She fell at his feet
and attempted to tell her melancholy tale; but convulsive sobs stifled
her utterance. He then took her unresisting hand, raised her up, led
her to a seat, and bade her compose herself before she attempted to
speak.
With a faltering tongue, and eyes which, like the lightning of
heaven, seemed capable of penetrating a heart of adamant, and in all
the energy and pathos of impassioned grief, she told her tale,—
imploring the warden, if he ever regarded his mother, or if capable of
feeling for the anguish of a woman, to have pity on them, and
instantly exert himself to restore the most dutiful of sons, and the
most faithful of lovers, to his humble petitioners, whose gratitude
should cease only with their lives.
“You are probably not aware,” said he, in a kindly tone, “of the
difficulty of gratifying your wishes. Wallace Maxwell has rendered
himself the object of vengeance to the English borderers; and, before
now, he must be in captivity so secure, that any measure to rescue
him by force of arms would be unavailing. But, for your sake, I will
adopt the only means which can restore him, namely, to purchase his
ransom by gold. But you are aware that it must be high, and I trust
your gratitude will be in proportion.”
“Everything in our power shall be done to evince our gratitude,”
replied the delighted Mary, a more animated glow suffusing her
cheek, and her eyes beaming with a brighter lustre,—“Heaven reward
you.”
“To wait for my reward from heaven, would be to give credit to one
who can make ready payment,” replied the warden. “You, lovely
Mary, have it in your power to make me a return, which will render
me your debtor, without in any degree impoverishing yourself;”—and
he paused, afraid or ashamed to speak the purpose of his heart. Such
is the power which virgin beauty and innocence can exert on the
most depraved inclinations.
Although alarmed, and suspecting his base design, such was the
rectitude of Mary’s guileless heart, that she could not believe the
warden in earnest; and starting from his proffered embrace, she with
crimson blushes replied, “I am sure, sir, your heart could never
permit you so far to insult a hapless maiden. You have spoken to try
my affection for Wallace Maxwell; let me therefore again implore you
to take such measures as you may think best for obtaining his
release;” and a fresh flood of tears flowed in torrents from her eyes,
while she gazed wistfully in his face, with a look so imploringly
tender, that it might have moved the heart of a demon.
With many flattering blandishments, and much artful sophistry,
he endeavoured to win her to his purpose; but perceiving that his
attempts were unavailing, he concluded thus:—“All that I have
promised I am ready to perform; but I swear by Heaven, that unless
you grant me the favour which I have so humbly solicited, Wallace
Maxwell may perish in a dungeon, or by the hand of his enemies; for
he shall never be rescued by me. Think, then, in time, before you
leave me, and for his sake, and your own future happiness, do not
foolishly destroy it for ever.”
With her eyes flashing indignant fire, and her bosom throbbing
with the anguish of insulted virtue, she flung herself from his hateful
embrace, and, rushing from his presence, with a sorrowful and
almost bursting heart, left the castle.
Widow Maxwell had a mind not easily depressed, and although in
great affliction for her son, did not despair of his release. She was
ignorant of Mary’s application to the warden, and had been revolving
in her mind the propriety of seeking an audience of the king, and
detailing her wrongs, both at the hands of the English marauders and
Sir John. She was brooding on this when Mary entered her cottage,
and, in the agony of despairing love and insulted honour, related the
reception she had met from the warden. The relation confirmed the
widow’s half formed resolution, and steeled her heart to its purpose.
After they had responded each other’s sighs, and mingled tears
together, the old woman proposed waiting on her friend the farmer,
declaring her intentions, and, if he approved of them, soliciting his
permission for Mary to accompany her.
The warden’s indolent neglect of duty was a subject of general
complaint; the farmer, therefore, highly approved of the widow’s
proposal, believing that it would not only procure her redress, but
might be of advantage to the country. He urged their speedy and
secret departure, requesting that whatever answer they received
might not be divulged till the final result was seen; and next
morning, at early dawn, the widow and Mary took their departure for
Stirling. King James was easy of access to the humblest of his
subjects; and the two had little difficulty in obtaining admission to
the royal presence. Widow Maxwell had in youth been a beautiful
woman, and, although her early bloom had passed, might still have
been termed a comely and attractive matron, albeit in the autumn of
life. In a word, her face was still such as would have recommended
her suit to the king, whose heart was at all times feelingly alive to the
attraction of female beauty. But, on the present occasion, although
she was the petitioner, the auxiliary whom she had brought, though
silent, was infinitely the more powerful pleader; for Mary might be
said to resemble the half-blown rose in the early summer, when its
glowing leaves are wet with the dews of morning. James was so
struck with their appearance, that, before they had spoken, he
secretly wished that their petitions might be such as he could with

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Advanced ICD-10 for physicians

including worker's compensation and

ICD 10 CM 2018 The Complete Official Codebook American

ICD 10 CM Documentation Essential Charting Guidance to

Personal Injury and Damage Ascertainment under Civil

How to Manual for Pacemaker and ICD Devices Procedures

Executive compensation : accounting and economic issues

Core Light Healing My Personal Journey and Advanced

Biomarkers for Traumatic Brain Injury 1st Edition Alan

Pediatric Orthopedics and Sports Medicine: A Handbook

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Names: Fukumoto, Eugene, author.

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Category 5: Find the Correct Activity Code................................................. 30

Dr. Michael Smith , Orthopedic Surgeon

Dr. Vincent Sghiatti , Family and General Practice

Dr. Donna Meeks, Dr. Dan Farris , DC

Conquering ICD-10— For Chiropractors

Online Courses by Eugene Fukumoto:

For more info, visit Eugene at:

Introduction to ICD-10, Including Worker’ s

Reasons to Avoid Relying on GEM Software

External Cause codes are used when a patient is injured or adversely

S33.0XXA Traumatic rupture of lumbar intervertebral disc— Initial

Providers must be cognizant that their documentation must support the

Structural Overview of the ICD-10-CM Book

1. An Introduction with instructions/guidelines

Worker’ s Compensation and Personal Injury practices will mainly be working

Code Structure Basics

ICD 9 Format ICD-10 Format

N N N . N N A N A/N . A/N A/N A/N A/N

Using ICD-10 Overview

1. Many ICD-9 codes do not have a one-to-one crosswalk to ICD-10. Many

Reviewing the Alphabetic Index in ICD-10, we find:

Components of ICD-10 and Their Usage

R10.1 Pain localized in the upper abdomen

Then, further classification is noted in the fifth character.

R10.10 Upper abdominal pain, unspecified

Severity is another Axis of Classification.

G44.0 Cluster headaches and other trigeminal autonomic cephalgias (TAC)

Etiology (cause) is the final Axis of Classification.

G44.5 Complicated headache syndromes

R10 Abdominal and pelvic pain

Five- and six-character subdivisions are used as follows:

R10.81 Abdominal tenderness

The sixth characters can be used to further subdivide fifth-character classifica-

R10.811 Right upper quadrant abdominal tenderness

By Sir Thomas Dick Lauder.

Towards the end of the seventeenth century, there lived a certain

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The predatory incursions of the Scots and English borderers, on

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