Osteopathies and Chondropathies (Category Codes M80–M94) . . . 312
Other Disorders of the Musculoskeletal System and Connective Tissue (Category Code M95) 315
Intraoperative and Postprocedural Complications and Disorders of Musculoskeletal System, Not Elsewhere Classified (Category Code M96) Periprosthetic Fracture Around Internal Prosthetic Joint (Category Code M97) and Biomechanical Lesions, Not Elsewhere Classified (Category Code M99) 315
Other Disorders of Kidney and Ureter (Category Codes N25–N29)
329
Other Diseases of the Urinary System (Category Codes N30–N39) 329
Diseases of Male Genital Organs (Category Codes N40–N53) 331
Disorders of Breast (Category Codes N60–N65) 331
Inflammatory Diseases of Female Pelvic Organs (Category Codes N70–N77) 332
Noninflammatory Disorders of the Female Genital Tract (Category Codes N80–N98) .
332
Intraoperative and Postprocedural Complications and Disorders of Genitourinary System, Not Elsewhere Classified (Category Code N99) 333
334
335
Chapter 20: Pregnancy, Childbirth, and the Puerperium 340
Introduction 341
Introduction to the Body System
Coding for Pregnancy, Childbirth, and the Puerperium
341
342
Pregnancy with Abortive Outcome (Category Codes O00–O08) and Supervision of High-Risk Pregnancy (Category Code O09) 344
Routine Outpatient Prenatal Visits 347
Edema, Proteinuria, and Hypertensive Disorders in Pregnancy, Childbirth, and the Puerperium (Category Codes O10–O16) 347
Other Maternal Disorders Predominantly Related to Pregnancy (Category Codes O20–O29) 348
Maternal Care Related to the Fetus and Amniotic Cavity and Possible Delivery Problems (Category Codes O30–O48) 349
Complications of Labor and Delivery (Category Codes O60–O77) 351 Encounter for Delivery (Category Codes O80 and O82) 352 Complications Predominately Related to the Puerperium (Category Codes O85–O92) 354
Other Obstetric Conditions, Not Elsewhere Classified (Category Codes O94–O9A) 354
Respiratory and Cardiovascular Disorders Specific to the Perinatal Period (Category Codes P19–P29) 366
Infections Specific to the Perinatal Period (Category Codes P35–P39) . . . . . . . . . . 366
Hemorrhagic and Hematologic Disorders of Newborn (Category Codes P50–P61) 367
Transitory Endocrine and Metabolic Disorders Specific to Newborn (Category Codes P70–P74) 368
Digestive System Disorders of Newborn (Category Codes P76–P78) 368
Conditions Involving the Integument and Temperature Regulation of Newborn (Category Codes P80–P83) and Other Problems with Newborns (Category Code P84) 368
Other Disorders Originating in the Perinatal Period (Category Codes P90–P96)
Congenital Malformations,
and Chromosomal
Congenital Malformations of the Nervous System (Category Codes Q00–Q07) 377
358
Coding Assignments 357 Case Studies
Chapter 21: Certain Conditions Originating in the Perinatal Period 362
Introduction
Coding Guidelines for Certain Conditions Originating in the Perinatal Period
362
363
Newborn Affected by Maternal Factors and by Complications of Pregnancy, Labor, and Delivery (Category Codes P00–P04) 364 Disorders of Newborn Related to Length of Gestation and Fetal Growth (Category Codes P05–P08) 365
Congenital Malformations of Eye, Ear, Face, and Neck (Category Codes Q10–Q18) 378
Congenital Malformations of the Circulatory System (Category Codes Q20–Q28) 379
Congenital Malformations of the Respiratory System (Category Codes Q30–Q34)
379
Cleft Lip and Cleft Palate (Category Codes Q35–Q37) 379 Other Congenital Malformations of the Digestive System (Category Codes Q38–Q45) 380
Congenital Malformations of Genital Organs (Category Codes Q50–Q56) 380
Congenital Malformations of the Urinary System (Category Codes Q60–Q64)
381
Congenital Malformations and Deformations of the Musculoskeletal System (Category Codes Q65–Q79) 382
Other Congenital Malformations (Category Codes Q80–Q89) and Chromosomal Abnormalities, Not Elsewhere Classified (Category Codes Q90–Q99) 383
Summary
383
Internet Links 383
Chapter Review
Coding Assignments
384
384
Case Studies 385
Chapter 23: Symptoms, Signs, and Abnormal Clinical Laboratory Findings 389
Introduction
390
Coding of Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified
390
Coding Guidelines for Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified 392
Guideline for Principal Diagnosis 392
Symptoms and Signs as Secondary Codes 393
Difference Between Inpatient and Outpatient Coding Guidelines 393
Chapter 18 Specific Coding Guidelines 394
Symptoms and Signs Involving the Circulatory and Respiratory Systems (Category Codes R00–R09) 394
Symptoms and Signs Involving the Digestive System and Abdomen (Category Codes R10–R19) 395
Symptoms and Signs Involving the Skin and Subcutaneous Tissue (Category Codes R20–R23) 395
Symptoms and Signs Involving the Nervous and Musculoskeletal Systems (Category Codes R25–R29) 395
Symptoms and Signs Involving the Genitourinary System (Category Codes R30–R39) . . .
396
Symptoms and Signs Involving Cognition, Perception, Emotional State, and Behavior (Category Codes R40–R46) 396
Symptoms and Signs Involving Speech and Voice (Category Codes R47–R49) 397
General Symptoms and Signs (Category Codes R50–R69) 398
Abnormal Findings on Examination of Blood Without Diagnosis (Category Codes R70–R79) and Abnormal Findings on Examination
of Urine Without Diagnosis (Category Codes R80–R82) 399
Abnormal Findings on Examination of Other Body Fluids, Substances, and Tissues, Without Diagnosis (Category Codes R83–R89) 399 Abnormal Findings on Diagnostic Imaging and in Function Studies, Without Diagnosis (Category Codes R90–R94), Abnormal Tumor Markers (Category Code R97), and Ill-defined and Unknown Cause of Mortality (Category Code R99) 400
Summary
Chapter 24: Injury, Poisoning, and Certain Other Consequences of External Causes 407
S
Injuries to the Head (Category Codes S00–S09) 414
Injuries to the Neck (Category Codes S10–S19) 414
Injuries to the Thorax (Category Codes S20–29)
Injuries to the Abdomen, Lower Back, Lumbar Spine, Pelvis, and External Genitals (Category Codes S30–S39)
415
415
Injuries to the Shoulder and Arm, Elbow, Wrist, and Hand (Category Codes S40–S69) 415
Injuries to the Hip, Thigh, Knee, Lower Leg, Ankle, Foot, and Toes (Category Codes S70–S99) 416
T Codes
417
Injuries Involving Unspecified Multiple Body Regions (Category Code T07) 417
Injury of Unspecified Body Region (Category Code T14) 417
Effects of Foreign Body Entering Through Natural Orifice (Category Codes T15–T19) 417
Burns and Corrosions (Category Codes T20–T32) 417
Frostbite (Category Codes T33–T34) 420
Other and Unspecified Effects of External Causes (Category Codes T66–T78) 422
Complications of Surgical and Medical Care, Not Elsewhere Classified (Category Codes T80–T88) 423
Chapter 25: External Causes of Morbidity 432
Coding External Causes of Morbidity
Transport Accidents (Category Codes V00–V99) 436
Pedestrian Injured in Transport Accident (Category Codes V00–V09) .
437
Pedal Cycle Rider Injured in Transport Accident (Category Codes V10–V19) 437
Motorcycle Rider Injured in Transport Accident (Category Codes V20–V29) 437
Occupant of Three-Wheeled Motor Vehicle Injured in Transport Accident (Category Codes V30–V39) 437
Car Occupant Injured in Transport Accident (Category Codes V40–V49) .
438
Occupant of Pickup Truck or Van Injured in Transport Accident (Category Codes V50–V59) 438
Occupant of Heavy Transport Vehicle Injured in Transport Accident (Category Codes V60–V69) 439
Bus Occupant Injured in Transport Accident (Category Codes V70–V79) 439
Other Land Transport Accidents (Category Codes V80–V89) 439
Water Transport Accidents (Category Codes V90–V94) 439
Air and Space Transport Accidents (Category Codes V95–V97) . . . . 440
Other and Unspecified Transport Accidents (Category Codes V98–V99) 440
Other External Causes of Accidental Injury (Category Codes W00–X58) .
440
Slipping, Tripping, Stumbling, and Falls (Category Codes W00–W19) 440
Poisoning by Adverse Effects of and Underdosing of Drugs, Medicaments, and Biological Substances (Category Codes T36–T50) 420 Toxic Effects of Substances Chiefly Nonmedicinal as to Source (Category Codes T51–T65)
441
Exposure to Animate Mechanical Forces (Category Codes W50–W64) 442
Accidental Non-Transport Drowning and Submersion (Category Codes W65–W74) 442
Exposure to Electric Current, Radiation, and Extreme Ambient Air Temperature and Pressure (Category Codes W85–W99) 442
Exposure to Smoke, Fire, and Flames (Category Codes X00–X08) 442
Contact with Heat and Hot Substances (Category Codes X10–X19)
443
Exposure to Forces of Nature (Category Codes X30–X39) . . . . 443
Overexertion and Strenuous or Repetitive Movement (Category Code X50) and Accidental Exposure to Other Specified Factors (Category Codes X52, X58) 443
Event of Undetermined Intent (Category Codes Y21–Y33) 444
Legal Intervention, Operations of War, Military Operations, and Terrorism (Category Codes Y35–Y38) 444
Complications of Medical and Surgical Care (Category Codes Y62–Y84) 444
Supplementary Factors Related to Causes of Morbidity Classified Elsewhere (Category Codes Y90–Y99) 445
Summary
Chapter Review
448
448 Coding Assignments
and Psychosocial Circumstances (Category Codes Z55–Z65) 469
Do Not Resuscitate Status (Category Code Z66) 469
Blood Type (Category Code Z67) 469
Body Mass Index (BMI) (Category Code Z68) 469
Persons Encountering Health Services in Other Circumstances (Category Codes Z69–Z76) 469
Persons with Potential Health Hazards Related to Family and Personal History and Certain Conditions Influencing Health Status (Category Codes Z77–Z99) 470
Additional Guidelines
Summary
Introduction to Z Codes
455
455
Persons Encountering Health Services for Examinations (Category Codes Z00–Z13) 456
Genetic Carrier and Genetic Susceptibility to Disease (Category Codes Z14–Z15) 460
Resistance to Antimicrobial Drugs (Category Code Z16) 463
Estrogen Receptor Status (Category Code Z17) 463
Persons with Potential Health Hazards Related to Communicable Diseases (Category Codes Z20–Z29) 463
Persons Encountering Health Services in Circumstances Related to Reproduction (Category Codes Z30–Z39) 464
Encounters for Other Specific Health Care (Category Codes Z40–Z53) 466
Persons with Potential Health Hazards Related to Socioeconomic
473
475
Internet Links 475
Chapter Review
Coding Assignments
476
477 Case Studies 478
Chapter 27: Introduction to ICD-10-PCS 482
Introduction 483 Code Structure
Format
483
484 Introduction 484 Index 485 Tables 486
ICD-10-PCS Coding Guidelines . . 487
Selection of Principal Procedure 489
Summary
Chapter Review
490
490
Chapter 28: Medical and Surgical Section 493
Introduction
Medical and Surgical Section Character Meanings
494
494
Section 494
Body Systems 494
ICD-10-PCS Official Coding Guidelines Relating to Body System 495 Root Operations 496
ICD-10-PCS Official Coding Guidelines Relating to Root Operation 501 Body Part 506
ICD-10-PCS Official Coding Guidelines Relating to Body Part 507 Approach 509
ICD-10-PCS Official Coding Guidelines Relating to Approach 510 Device 511
ICD-10-PCS Official Coding Guidelines Relating to Device 511 Qualifier
Instructor Resources
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Features of the Instructor Resources include:
Customizable presentations for each chapter, written in Microsoft PowerPoint™
The Instructor’s Manual, which contains class preparation information and complete answer keys for each chapter of the book.
Instructor’s Manual
Posted on the Instructor Companion Site in Adobe’s PDF format. Section I of the Instructor’s Manual features a 15-week lesson plan plus a course outline that can be modified to suit your course. Section II contains answer keys to the exercises, chapter reviews, coding assignments, and case studies that appear in the textbook.
Computerized Test Bank
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MINDTAP
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Learning Package for the Student Student Companion Website
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Computer-graded activities and exercises
Case studies
Medical Coding Trainer
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ABOUT THE AUTHOR
Mary Jo Bowie, MS, BS, AAS, RHIA, RHIT
Mary Jo has worked in the health information field for more than 38 years as a consultant, HIM department director, and college HIM and medical coding program director and associate professor and instructor. As consultant and owner of Health Information Professional Services in Binghamton, New York, she has consulted nationally in various levels of care, including inpatient hospital settings, ambulatory care settings, skilled nursing facilities, physician offices, and clinics. She is an active member of the American Health Information Management Association (AHIMA). She has held the following positions in the New York Health Information Management Association: education director and a member of the board of directors, and Ambulatory Care Coding Guidelines Committee chairperson. At the collegiate level, teaching both in the classroom and in an Internet-based format, she has taught numerous health information technology and coding and reimbursement courses. Mary Jo also conducts professional coding workshops for coders as well as for physicians and clinical staff. She is also an AHIMA-approved ICD-10-CM and ICD-10-PCS Train the Trainer. She has led more than 60 workshops for Cengage on ICD-10-CM and ICD-10-PCS.
Key Terms
Certified Medical Assistant (CMA)
(continued )
Certified Medical Billing Specialist (CMBS)
Certified Medical Record Technician (CMRT)
Certified Medical Reimbursement Specialist (CMRS)
Certified Outpatient Coder (COC)
Certified Professional Coder (CPC)
Certified Risk Adjustment Coder (CRC)
Introduction
Coding
Commission on
Accreditation of Allied Health Education Programs (CAAHEP)
Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191
ICD-10-CM
ICD-10-PCS
ICD-10 Procedure Coding System
International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)
International Classification of Diseases, Tenth Revision (ICD-10)
Medical Association of Billers (MAB)
Morbidity
Mortality
National Center for Health Statistics (NCHS)
Registered Health Information Administrator (RHIA)
Registered Health Information Technician (RHIT)
Registered Medical Assistant (RMA)
World Health Organization (WHO)
Medical coding is the assignment of numeric or alphanumeric digits and characters to specific diagnostic and procedural phrases. This coding, like any other language, needs to be translated to be understood, and each combination of numbers or of numbers and letters represents a diagnostic or procedural phrase.
EX AMPLE: The diagnostic phrase “appendicitis” is translated into diagnostic code K37 in the ICD-10-CM coding system. The procedural phrase “open total appendectomy” is translated into procedure code 0DTJ0ZZ in ICD-10-PCS.
By using ICD-10-CM and ICD-10-PCS codes, health care professionals can effectively collect, process, and analyze diagnostic and procedural information.
Professional Coding
Coding is the language used by insurance companies and health care providers to describe what brought a person to a facility for treatment and what services were performed. The ability of health care professionals to communicate and translate these codes is vital to the care and treatment rendered to the patient. These codes are also communicated to the insurance company, which is required to make payment for the patient’s care. All involved parties must be able to understand and fluently “speak” the coding language to convey the essence of the patient’s visit and treatment.
In the chapters that follow, the student will gain a greater knowledge of the language of coding, specifically ICD-10-CM and ICD-10-PCS. By the completion of this book, the student will have the knowledge base needed to become fluent in the language of ICD-10-CM and ICD-10-PCS coding, which is an ever-increasingly used tool in the health care industry.
History of Coding
ICD-10-CM, an abbreviation for the International Classification of Diseases, Tenth Revision, Clinical Modification, is an arrangement of classes or groups of diagnoses by systematic division that is used in the United States. ICD-10-CM is based on the official version of the International Classification of Diseases, Tenth
Revision (ICD-10), which was developed by the World Health Organization (WHO) in Geneva, Switzerland. ICD-10 is used throughout the world as a standard diagnostic tool for epidemiology, health management, and clinical purposes. In 1948, the WHO assumed responsibility for preparing and publishing the revisions to the ICD every 10 years. Thus, with every 10-year revision, the name of the current ICD changes.
EXAMPLE: ICD-8 was revised to become ICD-9; ICD-9 was revised to become ICD-10. An ICD-11 version for preparing implementation in Member States, including translations, was released on June 18 2018. During 2019 ICD-11 was presented at the Seventy-second Work Health Assembly. At this current time it is anticipated that the Member States of the World Health Organization will begin reporting health data using ICD-11 in January of 2022. For the most up-to-date information on ICD-11, visit http://www.who.int/classifications/icd/revision/en/. This website contains a wealth of information about ICD-11.
The ICD classification system was designed to compile and present statistical data on morbidity (the rate or frequency of disease) and mortality (the rate or frequency of deaths). Hospitals first used this form of classification to track, store, and retrieve statistical information. However, a more efficient basis for the storage and retrieval of diagnostic data was needed. In 1950, the Veterans Administration and the U.S. Public Health Service began independent studies of the use of the ICD for hospital indexing purposes. By 1956, the American Hospital Association and the American Association of Medical Record Librarians (now the American Health Information Management Association) felt that the ICD form of classification provided an efficient and useful vehicle for indexing hospital records.
With hospital indexing in mind, the WHO international conference published its eighth revision of the ICD in 1966. Health care professionals in some countries found that ICD-8 lacked the detail needed for diagnostic indexing. In the United States, consultants were asked to study ICD-8 for its applicability to various users. In 1968, the Advisory Committee to the Central Office on ICD published the International Classification of Diseases, Eighth Revision, adapted for use in the United States. It became known as ICDA-8 and was used for coding diagnostic data for both morbidity and mortality statistics in the United States.
In 1979, ICD-9-CM replaced earlier, less-specific versions of the classification system. ICD-9-CM streamlined the other versions of ICD classification into a single system that was intended for use primarily in U.S. hospitals. Please note that there is a difference between ICD-9 and ICD-9-CM. ICD-9 was developed by the WHO, and in the United States we take the ICD-9 version and modify codes to create the clinical modification of ICD-9 that will be used within the United States. The ICD-9-CM provided a more complete classification system for morbidity data to be used for indexing and reviewing patient records and medical care.
In 1992, the WHO published ICD-10, which is currently being used in many countries. In 1997, the National Center for Health Statistics (NCHS) began testing the ICD-10 system for implementation of the diagnostic codes in the United States. In the United States, the ICD codes are further developed into ICD-10-CM codes, which is the clinical modification of ICD codes. This modification allows for the ICD-10-CM codes to be more effectively used in clinical settings to capture diseases and signs and symptoms that patients display. In the United States, the National Center for Health Statistics (NCHS) is responsible for maintaining the ICD-10-CM diagnostic codes.
As the NCHS was testing ICD-10-CM, the draft and the preliminary crossfunctionality between ICD-9-CM and ICD-10-CM were made available on the NCHS website for public review and comment. In the summer of 2003, the American Hospital Association and the American Health Information Management Association conducted a field test for ICD-10-CM and reported the findings. Modifications were then made to the tenth revision.
In 2001, the Centers for Medicare and Medicaid Services funded a project to design a replacement system for the procedural codes of ICD-9-CM. The contract to redesign the procedural codes was awarded to 3M Health Information Systems. The new system is known as ICD-10 Procedure Coding System or ICD-10-PCS. The Centers for Medicare and Medicaid Services (CMS) is responsible for maintaining the procedure codes of ICD-10-PCS.
ICD-10-CM and ICD-10-PCS, when compared to ICD-9-CM, has additional information relevant to:
Ambulatory and managed-care encounters.
Expanded injury codes.
More combination diagnosis-symptom codes to reduce the number of codes needed to fully describe a condition.
Expanded use of sixth and seventh characters.
Laterality and greater specificity in code assignment.
On August 22, 2008, the U.S. Department of Health and Human Services (HHS) published a proposed rule to adopt ICD-10-CM and ICD-10-PCS to replace ICD-9-CM. On January 16, 2009, the final rule on adoption of ICD-10-CM and ICD-10-PCS was published with an implementation date of October 1, 2013. During 2012 the implementation date of October 1, 2013 was reviewed and extended to October 1, 2014. And again in 2014, the implementation date was changed to October 1, 2015.
This system has become the key storyteller to the insurance companies, explaining what brought the patient into the office or facility (by means of a diagnostic code), as well as what services the facility provided (by means of a procedural code). Because coding plays such a critical role in the reimbursement for services rendered, correct coding practices are essential
Health Insurance Portability and Accountability Act of 1996
The Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, was passed by Congress to improve the portability and continuity of health care coverage. The Administrative Simplification aspect of this legislation developed standards for the electronic exchange of health care data for administrative and financial transactions. The final rule on transactions and code sets mandated the use of standardized code sets for the electronic submission of health care data.
HIPAA mandates that ICD-9-CM diagnostic codes must be reported for diagnoses for all levels of care, including all hospital services, clinic services, long-term care, and physician offices. ICD-9-CM procedural codes are to be reported for inpatient hospital services. Health care providers must use ICD-9-CM codes to accurately report diagnoses and services provided on submitted insurance claims. The codes are used to determine not only payment, but also the medical necessity of care, which is defined by Medicare as “the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.” Thus, coders perform a vital role in the health care system.
ICD-10-CM and ICD-10-PCS codes replaced ICD-9-CM for use by inpatient facilities starting on October 1, 2015. Also on that date, ambulatory services and physician services started using ICD-10-CM codes for diagnosis and continued to use CPT codes for procedures.
Professional Coding Associations
To assist and promote correct coding and reimbursement, several organizations educate, train, and credential coders. Credentialing ensures the proper training and education of coders. As the transition is made from ICD-9-CM to ICD-10-CM and ICD-10-PCS, many of the following professional organizations will be offering educational materials to assist in the transition.
American Health Information Management Association (AHIMA)
The American Health Information Management Association (AHIMA) represents health information professionals who manage, organize, process, and manipulate patient data. Health-information professionals have knowledge of electronic and paper medical record systems, as well as of coding, reimbursement, and
research methodologies. The information that these professionals manage directly impacts patient care and financial decisions made in the health care industry. Members of AHIMA feel that the quality of patient care is directly related to the effectiveness of the information available.
Health care providers, insurance companies, and institutional administrators depend on the accuracy and quality of that information. For this reason, AHIMA members are trained to provide a level of service that maintains the quality and accuracy of the medical information they come into contact with.
AHIMA offers a number of certifications and credentials to ensure that its members meet the level of proficiency needed by educated professionals to manage health care information. Members receive the following certifications or credentials through a combination of education, experience, and performance on national certification examinations:
Once the certifications have been obtained, continuing education credits are required to maintain them. These credits can be obtained through conferences, seminars, classes, or other avenues of career development that AHIMA publishes and makes available to its members.
American Academy of Professional Coders (AAPC)
The American Academy of Professional Coders (AAPC) was founded to elevate the standards of medical coding. The AAPC provides networking opportunities through local chapter memberships and conferences. It also provides ongoing educational opportunities for members. AHIMA deals with all aspects of health information, whereas AAPC focuses on coding and reimbursement.
Like AHIMA, AAPC offers certifications for professional proficiency. The Certified Professional Coder (CPC) certification validates a coder’s proficiency in the physician office setting, the Certified Inpatient Coder, (CIC) certification validates proficiency in the inpatient hospital setting, and the Certified Outpatient Coder (COC) certification validates coding proficiency in outpatient hospital and outpatient facility coding. The AAPC also offers specialty credentials for experienced coders. To understand the various specialty coding examinations and credentials review the following website: https://www.aapc.com/certification/specialty-credentials.aspx.
AAPC also offers the Certified Risk Adjustment Coder (CRC) certification that validates that a coder can read a medical chart and assign the correct diagnosis (ICD-10-CM) codes for a wide variety of clinical cases and services for risk adjustment models. AAPC also offers specialty coding certifications. Information about these and other certifications from AAPC can be found at https://www.aapc.com/certification/
Continuing education credits are also required to maintain AAPC certification.
American Association of Medical Assistants (AAMA)
The American Association of Medical Assistants (AAMA) represents individuals trained in performing routine administrative and clinical jobs, including coding, that keep medical offices and clinics running efficiently and smoothly. Credentialing is voluntary in most states; a medical assistant is not required to be certified or registered. However, the AAMA offers the national credential of Certified Medical Assistant (CMA) certification for medical assistants. The Commission on Accreditation of Allied Health Education Programs (CAAHEP) collaborates with the Curriculum Review Board of the AAMA Endowment to accredit medical assisting programs in both public and private postsecondary institutions throughout the United States.
every morning, for the purpose of grazing, under the protection of a guard, which at once kept them from wandering too far, and also watched the movements of the Spanish army. Don Julian determined, if possible, to surprise the herd. For this purpose, he concealed himself, with his band, day after day, among the broken ground, near the river. But the guard was still too powerful and vigilant to allow him to make the attempt. At length, as if to reward him for his patience, fortune threw in his way, not only the object for which he sought, but one of far more importance to him. On a certain day, the governor of the place where the garrison was stationed came out, accompanied by a very slender escort, and ventured imprudently to cross the river, at the self-same spot where Julian lay concealed. He was instantly surrounded, and made prisoner. Almost at the same moment, the cattle, frightened by the explosion of a shell which fell among them, ran towards the river. The guard followed, but overtook them at such a distance from the city, that Julian thought himself justified in making the attack. It was attended with perfect success, and governor and cattle were conveyed in triumph to the British headquarters.
Another of these chiefs was named Juan Martin Diaz, or the “Empecinado.” When the news of the detention of Ferdinand at Bayonne first reached Spain, he was engaged as a farmer. Young, ardent, and daring, he threw aside his plough, and persuaded a neighboring youth, only sixteen, to join him. Their first object was to procure horses and arms. They took post upon the high road from France to Madrid, for the purpose of intercepting the French couriers. An occasion soon occurred. A party of six men were riding past a narrow defile. An old woman went out and arrested the progress of the last two, by offering them some fruit for sale. She detained them until the others were in advance some distance; then the two youths fired from their covert, and their victims fell. Long before the others returned for their comrades, their horses and arms were far away. These boys were soon joined by others, of which Juan was the chief; and, as he grew older and had more experience, his band increased, until it numbered one thousand five hundred
regarded as a valuable acquisition to his band. These wore a red ribbon in their hats, and a red collar to their jackets. In Arragon, a band of fifty robbers were adding to the miseries of that unhappy country. Having heard of their atrocities, Mina turned his course thither. He succeeded in surprising them. The greater part were killed on the spot, and the remainder sent as prisoners to Tarragona. Rations were voluntarily raised for his people, wherever they were expected, and given as freely at one time as they were paid for at another by the spoils of the enemy. It was in vain that the French made repeated efforts to crush this enterprising enemy. If his band were dispersed, it was only to unite, and, by striking a blow in some weak point, render themselves more formidable than before.
A large number of prisoners, and an amount of treasure, were to be sent from Vittoria to France. Twelve hundred men accompanied it as an escort. At the Puerto de Arlaban, they were attacked by the seemingly omnipresent Mina, of whose absence, in another part of the country, they thought themselves assured. They were entirely routed; but, unfortunately, two hundred of the prisoners were slain in the contest. Information of the journey of this escort had been procured from a new recruit in Mina’s band, who had his own object to accomplish by it. He was a gentleman of some standing, who was engaged to a beautiful Spanish lady. Her affections had been stolen from him by a wounded French officer, quartered in her father’s house. He had recovered, and was now taking his bride home to France. The former lover had sworn a deep revenge, and, unable himself to accomplish this object, had enlisted the powerful Mina on his side. When the band returned to their haunts, they carried with them six ladies, who were guilty of the same crime, viz., having accepted, as husbands, French officers. Their fate was, indeed, a sad one. The contest for them had been fierce in the extreme. They had seen their protectors, one by one, fall around them, fighting until the last breath in their defence; and now they were left helpless to the mercy of their conquerors. A mock trial was instituted. They were found guilty of aiding the enemies of their country, and all of them executed.
But Mina was not always successful. Not long after this, he had attacked and overcome a party of French. As he was conveying his prisoners to Robres, he was betrayed by one of his own men, and was attacked as suddenly as he had fallen upon others. His band were scattered, many of them slain, and he escaped, with great difficulty, with his own life. One week afterward, he appeared in the Rioja, with five thousand men, and attacked a Polish regiment, which was retiring to France. They were entirely routed. Mina enlarged his band by an accession of every one of the Spanish prisoners whom he had liberated, and filled his coffers with the booty. One million of francs fell into his hands, besides the equipages, arms and stores of all kinds, and a quantity of church plate. Two weeks after, he captured another convoy, going from Valencia to France. General Abbé now bent his whole force to disperse his troops. For three days in succession he followed Mina’s troops to their haunts, and each day defeated them; so that, on the last day, Mina was obliged again to flee alone for his life. Yet, not discouraged, he struggled on with various success, until at length he fell into the hands of the French, who sent him a prisoner to France. Great rejoicings were made when the capture of this formidable enemy was reported; but they soon found that they had little reason for joy, for his place at the head of the band was taken by his uncle, Francisco, who proved himself, if possible, even more formidable than his nephew. His various adventures would well fill a volume, and it is easy to see the interest they must have possessed when related around the bivouac fire on those mountains, where no one knew but that any moment might bring his army around them.
But to return to my own history. We were still pursuing our weary course, sometimes coming within sight of our enemies, and sometimes marching and counter-marching, when our leaders thought best to avoid a battle. We were still suffering the pangs of hunger, our principal food being a supply of ground bark. The soldiers continued to wander away, and often escaped, with their lives, from imminent peril. One of our men observed, at a little distance from the camp, a commotion in the bushes, which he
directed to Badajos, and, on the 3d of May, we sat down three leagues from its walls.
CHAPTER V.
Badajos. Its Capture by the French. Attempts to retake it by the English.—Wellington invests it in Person.—Assault upon Fort Christoval.—Storming of the Town.—Terrific Conflict.—The place sacked by the Victors.—Disgraceful Drunkenness and Debauchery of the Troops. The Main Body of the Army depart for Beira.
BADAJOS, the capital of the Spanish province of Estremadura, is situated near the Portuguese frontier, at the confluence of the small stream of the Rivillas with the Guadiana. It is very strongly fortified, both nature and art having contributed their stores to render its position impregnable. A huge rock, one hundred feet high, overlooks the meeting of the waters. On the top of this rock rises an old castle, venerable from its age, and itself a strong fortification. The town occupies a triangular space between the rivers, and is protected by eight curtains and bastions, from twenty-three to thirty feet high, with good counterscarps, covered way and glacis. On the left bank of the Guadiana there is a lunette, covering a dam and sluice, which commands an inundation. Beyond the Rivillas stands an isolated redoubt, called the Picurina. This is four hundred yards from the town. Two hundred yards from the ramparts, rises a defective crown-work, called the Pardaleras. On the right bank of the Guadiana rises a hill, crowned by a regular fort, three hundred feet square, called San Christoval. A bridge, supported by twenty-two stone arches, crosses the stream, and this is protected by a bridge head. The strength of this place made its possession a desirable object to both parties. It had been early invested by the French, under Soult, and vigorously assaulted. It was, however, well defended, and would probably have maintained its position, had it not been for the weakness and inefficiency of its
BADAJOS.
commanding officers, which caused the battle of the Gebora to terminate in a shameful defeat and immense loss to the Spanish army. Rafael Menacho was next made commander of the place. He sustained the siege with great spirit, and everything seemed to promise favorably, when Menacho was unfortunately killed, during a sally, and the command devolved upon Imas, a man most unfitted for this situation. He surrendered, almost without a struggle, to the French; although he had received certain information that a strong army was moving to his assistance, and would soon raise the siege. He demanded that his grenadiers should march out of the breach. Permission was granted, but they were obliged themselves to enlarge it, before they could do so. The French immediately took possession of the city, and strengthened its defences. Lord Wellington was much chagrined at the loss of this place, and early in May sent Lord William Stewart to invest it. The siege was carried on with vigor, but under great disadvantages, arising from want of the proper materials for construction of the works. In endeavoring to erect their batteries, the engineers were obliged to labor exposed to a heavy fire from the city, which proved so destructive, that, before one small battery against one of the outworks of the town was completed, seven hundred men and five officers had fallen. When, at length, on the morning of the 11th of May, this battery was completed, before night five of its guns were silenced by the enemy, and the rest were so exposed that it was impossible to man them. The same day news reached our army that the French army were coming to the relief of Badajos. Immediately our commander took steps to raise the siege, as to remain there would have exposed our whole force to destruction. On the night of the 13th, he removed all his artillery and platforms; and on that of the 14th, his guns and stores. But so secretly was this done, that the French were entirely ignorant of it, until, as the rear guard were about being drawn off, they made a sally, and, of course, discovered it. Soon after this, the battle of Albuera occurred.
ASSAULT UPON FORT
Our own division was not, however, engaged in this battle, having been ordered to Campo Mayor,
CHRISTOVAL. where, on the 24th, orders reached us that we were again to march for Badajos, Lord Wellington having resolved to invest it in person. We immediately marched, and arrived on the evening of the 27th, where we found Lord Wellington, with ten thousand men. During the absence of our army, Phillipon, the governor of the place, had entirely destroyed the little remains of fortifications left by them, repaired all his own damages, and procured a fresh supply of wine and vegetables from the country. He had also mounted more guns, and interested the towns-people on his side. The works of the siege were commenced under Wellington’s own direction, on the 29th, and carried on a week, with various success. Then it was resolved to make an assault upon Fort Christoval. The storming party, preceded by a forlorn hope, and led by Major McIntosh, with the engineer Forster as a guide, reached the glacis and descended to the ditch about midnight, on the night of the sixth of June. The French had, however, cleared all the rubbish away, so that seven feet perpendicular still remained; and above this were many obstacles, such as carts chained together, pointed beams of wood, and large shells ranged along the ramparts, to roll down upon the assailants. The forlorn hope, finding that the breach was still impracticable, was retiring, with little loss, when they met the main body, leaping into the ditch with ladders, and the ascent was again attempted; but the ladders were too short, and the confusion and mischief occasioned by the bursting of the shells was so great that the assailants again retired, with the loss of more than one hundred men. Two nights after, a second attack was made, but met with no better success. The British troops, with loud shouts, jumped into the ditch. The French defied them to come on, and at the same time rolled barrels of powder and shells down, while the musketry made fearful and rapid havoc. In a little time, the two leading columns united at the main breach; the supports also came up; confusion arose about the ladders, of which only a few could be reared; and the enemy, standing on the ramparts, bayoneted the foremost assailants, overturned the ladders, and again poured their destructive fire upon the crowd below. One hundred and forty men had already fallen, and yet not a single foot had been gained, nor
was there one bright spot in the darkness to encourage them to proceed. The order was given to retire. The next day, Wellington heard that the army of Soult was again advancing to attack him; and as to receive battle there would throw all the disadvantage on his side, he thought best to raise the siege. On the 10th, the stores were all removed, and the siege turned to a blockade, which was afterwards terminated, when the armies of Marmont and Soult, having effected a junction, advanced to its relief. It was nearly a year before the allied army again found it desirable to approach Badajos. Meanwhile the war was carried on with great activity, although with varied success.
My own time was passed with the regiment to which I belonged, either in the mountains, or in foraging or bringing supplies, as circumstances dictated. Although again and again engaged in light skirmishes with small bodies of the enemy, occupied as our own regiment were, it was not my fortune to engage in a general battle, until the last siege of Badajos. And as this city was one of the most important, and its siege the best sustained of any on the Peninsula, I shall give an account of it more in detail than I have thought best to do of the rest.
LAST SIEGE OF BADAJOS.
The unfavorable issue of the two former investments, had induced Lord Wellington to wait until a combination of favorable circumstances should at least give more hope of success. The auspicious moment had, in his view, now arrived. The heavy rains which occur at this season of the year would so raise the rivers in the high lands, where his troops were located, that there would be no risk of their detention in proceeding at once to the Alemtejo, while this same flow of waters, in the more level portion occupied by the French, would prove a fatal impediment to the junction of their forces, which were at this time considerably scattered, owing to the difficulty of obtaining provisions. Regiments were despatched, therefore, to bring all the stores of clothing and provisions from the different points where they had been left, and concentrate them near Badajos.
General Picton now resolved to take the fort by assault. Its external appearance did not indicate much strength, and he hoped for an easy victory. But the event proved that these appearances were deceptive. The fort was strong; the ditch fourteen feet perpendicular, and guarded with thick, slanting poles, and from the top there were sixteen feet of an earthen slope. Seven guns were mounted on the walls, and two hundred men, each armed with two loaded muskets, stood ready to repel all intruders. Loaded shells were also ranged along the walls, to be pushed over, in case of an attack. General Kempt took the direction of the assault, which was arranged for the night of the 25th. Five hundred men were selected from the third division, of which two hundred were stationed in the communication of San Roque, to prevent any assistance reaching the fort from the town; one hundred occupied a position at the right of the fort, one hundred at the left, and the remainder were held as a reserve, under the command of Captain Powis.
About nine o’clock, the signal was given, and the troops moved forward. The night was very clear, although there was no moon; and the fort, which had loomed up in the darkness still and silent, as though untenanted, answered back the first shot of the assailants with a discharge that caused it to resemble a sheet of fire. The first attack was directed against the palisades in the rear; but the strength of these, and the destructive fire poured down upon them, obliged them to seek some weaker part. They turned to the face of the fort; but here, the depth of the ditch, and the slanting stakes at the top of it, again baffled their attempts. The enemy lost not a moment in pouring their fire upon the assailants, and the loud death-screams told that the crisis was becoming more and more imminent. The alarm-bells in the city itself now rung out their shrill sounds, the guns on the walls and on the castle opened on the assailants, rockets were thrown up by the besieged, and the answering shots from the trenches served to increase the tumult. All eyes were turned in the direction of the fort. A battalion, hastily sent out from the city, advanced to its aid; but they had scarcely entered the communication, when the troops stationed there rushed to the
