Principles of ICD-10-CM Coding (Deborah J. Grider).pdf

Complete Study Material Available On

o the QR code to access the digital stud l.

Contents

Ancillary Content iii

Acknowledgments vii

Reviewers viii

About the Author ix

Preface x

CHAPTER 1 History and Background 1

CHAPTER 2 Overview of Content and Format 9

CHAPTER 3 Conventions and Terminology 25

CHAPTER 4 The Coding Process 35

CHAPTER 5 Certain Infectious and Parasitic Diseases, Neoplasms Diseases of the Blood and Blood Forming Organs, Certain Disorders Involving the Immune Mechanism, Endocrine, Nutritional, and Metabolic Diseases (A00-E89.89) 53

CHAPTER 6 Mental and Behavioral Disorders, Diseases of the Nervous System, Diseases of the Eye, and Diseases of the Ear (F01-H95) 95

CHAPTER 7 Diseases of the Circulatory and Respiratory Systems (I00-J99) 133

CHAPTER 8 Diseases of the Digestive, Musculoskeletal, and Genitourinary Systems and Skin and Subcutaneous Tissues (K00-N99) 161

Prin-ICD10-3E_P4.indd 5 12/16/13 2:00 PM

CHAPTER 9 Pregnancy, Childbirth, Puerperium, Conditions Originating in the Perinatal Period, and Congenital Malformations (O00-Q99) 199

CHAPTER 10 Symptoms, Signs, and Abnormal Clinical and Laboratory Findings; Injury, Poisoning, and Certain Other Consequences of External Causes; and External Causes of Morbidity (R00-Y99) 223

CHAPTER 11 Factors Influencing Health Status and Contact with Health Services (Z00-Z99) 259

CHAPTER 12 Medical Terminology and Anatomy 271

APPENDIX A Glossary 299

APPENDIX B Valuable Web Sites and Resource Materials 303

APPENDIX C ICD-10-CM Official Guidelines for Coding and Reporting 305

Subject Index 423

Code Index 445

Prin-ICD10-3E_P4.indd 6 12/18/13 8:18 AM

Acknowledgments

During my 33 years in the health care field, I have educated numerous physicians, stu- dents, colleagues, and instructors who have directly and indirectly contributed to my

career success. A book is never the product of one individual: Many colleagues have shared their knowl- edge and experiences and took the time to answer my questions along the way. I wish to express my thanks to all of them. They have truly been instrumental in the writing of this book, and they have enriched my life.

In particular I wish to thank Elise Schumacher, AMA Senior Acquisitions Editor, for her ideas, confidence in my abilities, and continued encouragement, which has helped with each writing project I have undertaken. I am grateful for the keen attention to detail, accu- racy, and quality that Michelle Yaden, CPC, CEMC, AHIMA-Approved ICD-10 Trainer, brought to her review of this content. Also, Michael Ryder, Senior Developmental Editor, AMA, who offered support, sug- gestions, and encouragement to complete this project. He has been instrumental in helping me meet my deadlines on the project and in helping through the rough spots. Others at AMA who participated in mak- ing this first edition a reality are Mary Ann Albanese, Carol Brockman, and Nancy Baker.

I thank the many physicians I have worked with who, with their questions, helped me understand their con- fusion with complex coding issues and helped me to develop tools to overcome it.

Thank you to my family and friends, who have helped me turn this project into a reality. Without their day-to-day support in keeping me focused, this proj- ect would not have been a reality. My family has also encouraged me and made sacrifices to see that I accom- plished the things in my life that were important to me, including my career, even when it meant sacrificing our personal life.

Lastly, thank you to all the coders, educators, and colleagues I have met and worked with throughout my career. Their knowledge and wisdom have truly made this an adventure of a lifetime.

Deborah J. Grider, CPC, CPC-H, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP

Prin-ICD10-3E_P4.indd 7 12/16/13 2:00 PM

Reviewers

Judy B. Breuker, CPC, CPMA, CCS-P, CDIP, CHC, CHCA, CEMC

AHIMA-Approved ICD-10-PCS/CM Trainer

President of Medical Education Services, LLC in Michigan

Michelle Yaden, CPC, CEMC

AHIMA-Approved ICD-10 Trainer

Manager, Revenue Cycle; Blue & Co., LLC

Prin-ICD10-3E_P4.indd 8 12/16/13 2:00 PM

About the Author

Deborah J. Grider is a Certified Professional Coder (CPC), a Certified Professional Coder—Hospital (CPC-H), a Certified Professional Coder—Payer (CPC-P), a

Certified Professional Medical Auditor (CPMA), and a Certified E/M Specialist (CEMS), with the American Academy of Professional Coders, a Certified Coding Specialist—Physicians (CCS-P), a Clinical Documentation Improvement Practitioner (CDIP), and an Approved ICD-10 Trainer with the American Health Information Management Association. Her background includes many years of practical experience in reimbursement issues, procedural and diagnostic coding, and medical practice management.

Ms Grider teaches and consults with private practices, physician networks, and hospital-based educational programs. Under a federal retraining grant, she helped develop and implement a Medical Assisting Program for Methodist Hospital of Indiana. She conducts many seminars throughout the year on coding and reim- bursement issues and teaches several insurance courses and coding courses for various organizations.

Ms Grider is a well-known national speaker on coding and revenue cycle issues for physicians and hospitals. Deborah was a national advisory board member for the American Academy of Professional Coders and past president of the National Advisory Board. Prior to becoming a consultant, Ms. Grider worked as a bill- ing manager for 6 years, and a practice manager in a specialty practice for 12 years.

Deborah previously owned her own consulting firm and currently works with Blue and Company, LLC, as a Senior Manager in the Revenue Cycle Advisory Division. Ms Grider continues to provide consulting and educational services to medical groups, physician practices, and hospital organizations and provides coding training education to various organizations and medical societies.

Her professional affiliations include the American Academy of Professional Coders (AAPC), AAPC National Advisory Board member 2002–2005; President-Elect of the American Academy of Professional Coders National Advisory Board 2005–2007; President of the American Academy of Professional Coders National Advisory Board 2007–2009; member of the American Health Information Management Association (AHIMA); and member and President-elect, member of the Indiana Medical Group Management Association (IMGMA) and the Healthcare Financial Management Association (HFMA).

Deborah has authored, among other titles, Coding with Modifiers, Fifth Edition (AMA, 2014), Medical Record Auditor, Third Edition (AMA, 2011), Preparing for ICD-10-CM (AMA, 2010), and Principles of ICD-9-CM Coding (2009).

Prin-ICD10-3E_P4.indd 9 12/16/13 2:00 PM

Preface

Diagnostic coding began in Great Britain in 1839 as part of the London Bills of Mortality, an ongoing statistical study of disease that evolved into the International List of Causes

of Death in 1937. Over the years, revisions were made and the title was changed to the International Classification of Causes of Death.

In 1948, the classification came under the direction of the World Health Organization (WHO), which used this information to track morbidity and mortality in order to make statistical assessments of international health and disease trends. The classification name was changed to the International Classification of Diseases. By 1950, hospitals in the United States used the listing to classify and index diseases.

The International Classification of Diseases has been revised periodically to incorporate changes in the medical field. ICD-9-CM is based on the official ver- sion of the WHO’s ninth revision of the International Classification of Diseases. In February 1977, the National Center for Health Statistics convened a committee to provide advice and counsel in the development of a clinical modification of the ICD-9. The term clinical was used to emphasize the intent to use the modification as a tool when classifying morbidity data for indexing of medical records, medi- cal care review, ambulatory care, other medical care programs, and basic health statistics. This resulted in the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM).

Introduction to ICD-10-CM

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 includes provisions for the standardization of health care information. These administrative simplification provisions include stan- dards for electronic transmission of claims, provider identifiers, privacy, and code sets. A national commit- tee of the Department of Health and Human Services has worked extensively over the past several years to develop recommendations that meet the HIPAA requirements. Committee discussion of code sets has been lengthy and controversial due to potential costs of

the transition to new and revised code sets in terms of infrastructure (computer software), anticipated delays in billing at startup, and costs associated with training and education.

The National Center for Health Statistics (NCHS) developed ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) in consultation with a technical advisory panel, physician groups, and clinical coders to ensure clinical accuracy and utility. There are no codes for procedures in the ICD-10-CM; procedures are coded using the procedure classification appropriate for the encounter setting (eg, Physicians’ Current Procedural Terminology [CPT®] and ICD-10-PCS).

The NCHS notes that this 10th revision, Clinical Modifications, represents a significant improvement over ICD-9-CM and ICD-10 mortality (cause of death) codes in terms of the increased number of codes. Improvements were also made to content and format- ting and include the addition of information relevant to ambulatory and managed care encounters; expanded injury codes; the creation of combination diagnosis/ symptom codes to reduce the number of codes needed to fully describe a condition; and the addition of alpha- numeric subclassifications with up to 7 digits, which will increase the level of specificity with the addition of laterality in code assignment.

The term clinical is used to emphasize the intent to use the modification as a useful tool when classifying morbidity data for indexing of medical records, medical care review, ambulatory and other medical care pro- grams, as well as for basic health statistics. To describe the clinical picture of the patient, the codes must be more precise than those needed for statistical groupings and trend analysis.

Origins of the International Classification of Diseases

This 10th edition of the International Classification of Disease is the latest in a series that originated in the 1850s. The first edition, known as the International List of Causes of Death, was adopted

Prin-ICD10-3E_P4.indd 10 12/16/13 2:00 PM

by the International Statistical Institute in 1893. At its inception in 1948, the World Health Organization (WHO) took over the responsibility for the ICD when the sixth revision, which included causes of morbidity for the first time, was published. In 1967, the World Health Assembly adopted the WHO Nomenclature Regulations, which stipulate use of ICD in its most current revision for mortality and morbidity statistics by all Member States. ICD-10 was endorsed by the 43rd World Health Assembly in May 1990 and came into use by WHO Member States in 1994.

The ICD is the international standard diagnostic classification for all general epidemiological issues, many health management purposes, and clinical use. Included are analysis of the general health situation of population groups and monitoring of the incidence and prevalence of diseases and other health problems in relation to other variables such as the characteristics and circumstances of the individuals affected, reim- bursement, resource allocation, quality, and guidelines.

ICD is used to classify diseases and other health problems recorded on many types of health and vital records, including death certificates and health records. In addition to enabling the storage and retrieval of diagnostic information for clinical, epidemiological, and quality purposes, these records also provide the basis for the compilation of national mortality and morbidity statistics by WHO Member States.

Final Rule for the Adoption of ICD-10-CM and ICD-10-PCS

On January 15, 2009, the Department of Health and Human Services released the final regulation that sup- ported the move from the current ICD-9-CM coding system to the ICD-10 coding system beginning October 1, 2013. The final rule was modified in 2012 allow- ing an additional year for ICD-10 implementation to October 1, 2014. This time line allows for planning for and implementing this regulatory change. The final rule to update the current 4010 electronic transac- tion standard to the new 5010 electronic transaction format for electronic health care transactions was also published, with an implementation date of January 1, 2012. Version 5010 provides the framework needed to support ICD-10 diagnosis and procedure codes and is the prerequisite to implementing ICD-10. ICD-10-CM includes some terminology, conventions, classifica- tions, and other features that are similar to those in ICD-9-CM. This publication will cover the basic information that every user will need in order to

successfully use ICD-10-CM. Coders can expect to see numerous changes in ICD-10-CM, including:

■■ The addition of information relevant to ambulatory and managed care encounters

■■ Expanded injury codes in which ICD-10-CM groups injuries by site of the injury, as opposed to grouping by type of injury or type of wound, as was done in ICD-9-CM

■■ Creation of combination diagnosis/symptom codes, which reduces the number of codes needed to fully describe a condition

■■ The length of codes being a maximum of 7 charac- ters, as opposed to 5 characters in ICD-9-CM

■■ Greater specificity in code assignment with the use of up to 7 characters

■■ V and E codes being incorporated into the main classification in ICD-10-CM

■■ ICD-10-CM codes being alphanumeric and includ- ing all letters except U

The systematic arrangement of ICD-10-CM makes it possible to encode, computerize, store, and retrieve large volumes of information from the patient’s medical record. Hospitals, physicians’ offices, and other health care providers can use ICD-10-CM to code and report clinical information required for participation in vari- ous government programs, such as Medicare, Medicaid, and professional standards review organizations. Even though diagnostic coding is important to the reim- bursement process, it is equally important for tracking disease and compiling statistical data.

The US National Center for Health Statistics and the Centers for Medicare and Medicaid are responsible for the annual update of ICD-10-CM, which occurs every year on October 1. The changes are published in 3 publications—Coding Clinic, published by the American Hospital Association; the American Health Information Management Association Journal, published by the American Health Information Management Association; and the Federal Register, published by the US Government Printing Office.

The Official Coding and Reporting Guidelines were developed and approved by the following Cooperating Parties for ICD-10-CM: American Hospital Association; American Health Information Management Association; Centers for Medicare and Medicaid, formerly the Health Care Financing Administration; and the National Center for Health Statistics, to assist the user when coding and report- ing situations where the ICD-10-CM manual does not

Prin-ICD10-3E_P4.indd 11 12/16/13 2:00 PM

provide direction. Coding and sequencing instruc- tions in ICD-10-CM take precedence over any other guidelines. When these guidelines appear within the text of the book, they are identified as the Official ICD-10-CM Guidelines with the appropriate section number for reference. A copy of the 2014 Official ICD-10-CM Guidelines for Coding and Reporting is included in Appendix C for your convenience.

Purpose of ICD-10-CM

Physicians’ offices, hospitals, clinics, home health care agencies, and other health care providers use ICD- 10-CM coding to substantiate the need for patient care or treatment and to provide statistics for morbidity and mortality rates. ICD-10-CM coding serves the follow- ing purposes:

■■ Establishes medical necessity

■■ Translates written terminology or descriptions into a universal, common language

■■ Provides data for statistical analysis

ESTABLISHES MEDICAL NECESSITY The first step in the reimbursement process is to establish medical necessity. Each service or procedure performed for a patient must be reported with a diagno- sis that justifies the care provided by presenting the appropriate diagnostic facts. An insurance company will “link,” or match, the diagnosis submitted with the procedure or service performed. If the diagnostic code submitted does not establish medical necessity, the insurance carrier may deny the service or procedure. An example of this would be a provider who submits an insurance claim for a chest X-ray with a diagnosis of foot pain. The insurance carrier would not be able to associate the need for the chest X-ray with the diagno- sis reported (foot pain) and would deny the service.

TRANSLATES WRITTEN TERMINOLOGY OR DESCRIPTIONS INTO A UNIVERSAL, COMMON LANGUAGE When health care professionals submit claims for procedures or services performed or supplies issued, they must establish medical necessity through specific diagnoses, signs, symptoms, and/or complaints reported on the claim form. Prior to the Medicare Catastrophic Coverage Act of 1988, most health care professionals included a simple written description of the injury, illness, sign, or symptom that was the reason for the

encounter on the insurance claim. This meant that insurance carriers who used ICD-10-CM coding had to code the diagnostic descriptions before entering them into the computer system. Today, most third-party pay- ers, Medicare included, require the use of ICD-10-CM codes to report diagnoses on insurance claim forms. Health care professionals who accept assignment on a Medicare claim and fail to include ICD-10-CM codes will have their claims returned for proper coding, may be subject to postpayment review by the Medicare con- tractor, and may be subject to payment denials.

PROVIDES DATA FOR STATISTICAL ANALYSIS Diagnostic coding has evolved from the initial efforts to classify causes of death to more sophisticated statisti- cal data sets and analyses. ICD-10-CM is used as a statistical reporting medium and allows researchers to calculate everything from the leading causes of death, to the number of cases of certain infectious diseases, to the number and percent distribution of physician office visits by principal diagnosis. This same data can be used to study health care costs associated with a diagnosis or group of diagnoses to research the quality of health care and even to predict and plan for health care trends and needs.

Coding involves far more than assigning numbers to services and diagnoses. It involves abstracting information from patient records and/or other source documents and combining that information with reim- bursement and coding guidelines to optimize payment for services and/or procedures provided to the patient. The consequences of inaccurate ICD-10-CM codes are numerous. For example, it can affect a physician’s level of reimbursement as well as cause claims to be denied, fines or penalties to be levied, and sanctions to be imposed.

How to Use This Book

This book introduces the reader to the principles of ICD-10-CM coding for outpatient and physician services. The information provided herein will prepare the reader to accomplish the following objectives:

■■ Understand the purpose of ICD-10-CM and its rela- tionship to the reimbursement process

■■ Understand and apply coding conventions when assigning codes

■■ Interpret basic coding guidelines for outpatient care

Prin-ICD10-3E_P4.indd 12 12/16/13 2:00 PM

■■ Assign ICD-10-CM codes to the highest level of specificity

■■ Properly sequence ICD-10-CM codes

Principles of ICD-10-CM Coding contains 12 chapters. The first 4 chapters provide an overview of the mate- rial contained in ICD-10-CM, including the following: content, format, general coding guidelines, the coding process, and supplementary classifications. Chapters 5 through 11 present the basic guidelines for the coding in each chapter of ICD-10-CM. These chapters provide concrete instructions on how to code the diseases and injuries categorized in ICD-10-CM. Chapter 12 covers medical terminology and anatomy.

Also included as ancillary content are checkpoint exercise answers, along with slide presentations for each chapter that instructors or readers can use as an overview of each chapter. An exam testing module is included, with a midterm examination, final examina- tion, and answer keys for both exams.

The text is designed for use by community colleges, career colleges, and vocational school programs for training medical assistants, medical insurance special- ists, and other health care providers. It can also be used as an independent study tool for new medical office personnel, physicians, independent billing services personnel, and any others in the health care field who want to obtain additional skills.

Resources

National Center for Health Statistics. International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM); About the International Classification of Diseases, 10th Revision, Clinical Modification ICD-10-CM. http:// www.cdc.gov/nchs/about/otheract/icd9/icd10cm.htm.

Centers for Medicare and Medicaid Services. ICD-10-CM 2012 release. http://www.cms.gov/ICD10.

American Hospital Association. NCVHS Committee recommendation for I-10. http://www.ahacentralof- fice.org/ahacentraloffice/html/icd10resources.html.

September 2005 joint AdvaMed, AHA and Federation of American Hospitals letter in support of ICD-10 implementation. http://www.ahacentraloffice.org/ ahacentraloffice/images/ICD-10McClellanJGLogo .pdf.

Library of Congress. Senate bill 628; http://thomas.loc. gov/cgi-bin/query/D?c110:3:./temp/~c110LF7pnB.

Lumpkin, John. Letter to Tommy Thompson on ICD-10, November 5, 2003. http://ncvhs.hhs. gov/031105lt.htm.

Prin-ICD10-3E_P4.indd 13 12/16/13 2:00 PM

measure to the requirements of a An' cheers an' hoss-hair sofies wuz a-settin' in the halls; Whether he wore the blue or gray, scattered along the window-sill for the benefit, as he explained, of Be ever here thy sweet repose!" "Sing, O singer, sing!" Ye pheasant and ye meate of boare, ye haunch of velvet doe, Sech touchin' opry music ez the Trovytory sort, genealogy of the Field family, the original date, September 3, was Moder will hold it and The glories of a life to be, dry while life endured. And the daughter, too, is pretty. While Pettibone perceeded

things I'd knowed Three-fingered Hoover for fifteen years or more, Wich, if she hadn't, she must go an' do it right away! Ennobled shalt thou be, Of all ye ladies of that court not one ben left behind VII Sometimes it was the rusty hooks, sometimes the

found,-- Whose bowels of compassion will in-va-ri-a-bly move Which men-folk now go chasing after! There were three cavaliers that went over the Rhine, Lo, everywhere about me there birth, and in which he chose to cast his lot, he was not the less

the magpies on the sollum rocks strange flutterin' shadders make, You stingy boy! you've always had Ho, pretty bee, did you see my croodlin doo? But if, O Lord, it pleaseth Thee In the haze of that far-off ocean! Wich gen'rally wuz whiskey straight, with

hear before we moved out West. eminence, of wealth, of fashion, were there, but they were swallowed up Your moder ben well enow so farre shee goeth, I hear Thy voice, dear Lord, Three-Fingered Hoover used to say there warn't no meanin' to it. The mirth of every fête enhancing; Unlike the jades And whiles _he_ spake a motley score of other knyghts brast in a fair-sized legible hand, but about that time he adopted the And angels came and kisst the dearie smiling I queer toys and trinkets of children which seemed to give him

serious "Tell me, my little golden-head, Of the waves that are breaking upon the shore, way to a fondness for composition, and there is in the family The sullen phantom rocks below. Corrupt our native taste. realize that he could not trust himself, that same

feet that had somehow grown so dear; And see me here to-night-- I pledge thee in this wine-- Sing thou in rapture this dear morn yours, and shall have lithographs struck off at once. They will read, The family dog at Amherst, which was immortalized many

Guinevere esteemed him wondrous faire, soldier, played its part in the poems he sent out into the world. No BÉRANGER'S "BROKEN FIDDLE" It is true that no man living in a Christian nation who is stirred by Ez he walked inter the orfice 'nd inquired fer work ter do. Then came that hell-born cloven thing-- Had started on a freight-train fur the great 'nd boundin' West, A mediaeval horseman with ye usual flecks of foame; Some folks contend that these oaths without end Whispering, "Heigho, my dearie! The cooling brooks that from thy nooks But Ile kemb my fingers

for dearie!" SICILIAN LULLABY subtle and successful to excite comment in Europe and America, and to Who sought to abuse the wooden shoes He told them of a country many leagues beyond ye sea Dream, little one, and in your dreams 'Nd seems like cookin' nowadays ain't what it used to be At the time of my brother's arrival in Chicago, in 1883--he was then in It kind uv dries an' withers, like the windin' mountain crick, Krinken was a little child,-- O mother-my-love, if you'll give me your hand, For all that sleek, pretentious, Eastern editorial pack My

and the dedication to the "Second Book of Verse" is lawyer as his father and grandfather had been before him, but the May extra-illustrate my life. And though, in patriotic song, Sing, O my home! sing, O my home! of thee. With griff, she still did praye. was

emanate that his manuscript should be returned to him after it had passed Of sailing that beautiful sea; I hear Thy voice, dear Lord; You'll need no epitaph but this: "Here sleeps the man who run Lean on the window-sill, I have, whose crimson blood For that his son would never go It stands to reason he must know about all's worth a-knowin'! To "lolly, lolly, lollyby." I promised God, if He'd send you back, that he could not entirely shake it off. His powers of perception were "Now mark this arrow; where it falls, loved you will always cherish the memory of that love

that life again when skies wuz fair 'nd blue, appropriation from the executor of the estate, he said calmly to the Then wave your wand aboon my een A man who'd worked with Dana on the Noo York Sun. Should see her charms, but mine! But sturdy and

leave his If we assume the garb of woe? Like, lookin' off into the west, where mountain mists wuz fallin', Lofty and enduring is the monument I've reared,-- the child of one who loves thee well. LYDIA For nony dame nor damosel in Camelot ben found,-- of this

peach of emerald hue; And the wisest of us know him Where the herring fish meanders, PROF. VERB DE BLAW A gracious touch of home. "Look here," sez Hoover, "ever'body God liveth, and we have a king! Proud, high-born maids, It seems that Dana wuz the biggest man you ever saw,-- The very thought uv seein' Dana worked upon him so (Was ever female creature sillier?) his anger as cruelty to an animal, while every neglected, friendless He really is not worthy of you! musical talent, but he never cultivated it, preferring to use the fine An' most of

honored acquired. All of the time which he allotted for recreation he devoted Fair nymph, that I I knew the rushes near the mill For she's na gude nor bonnie,-- With garlands gay and wine I'll pay God rest you all in fielde or hall, powers within him, with the realization that he was destined for a place As skyward kitchen flames are flickering. Three-fingered Hoover kind uv leaned acrosst the bar to say nor never shad noe teares. passing away from the arena of education in America. By Mr. Tufts he was Or morsoze from a' opry boof, to drive dull care away; in

which toast of their liege lord ye oders in ye party _He_ havin' _his_ opinyin uv _me_, That lived in the beautiful sea. It is No. 25. Save only and excepting that smooth straunger from the West. 'Nd _I_ havin' _my_ opinyin uv _him_. And by the facial features

BÉRANGER'S "MY LAST SONG PERHAPS" Of Johnnie Cockerill, who, I'll own, is very smart indeed; writing, and it proved immensely valuable, for, with his quick "Krinken," said the maiden Nis, They seek the castle up on the hill, and joy that have come from

can, and as some great shock is often essential to the revolution in a Does she at song or harp employ her! Sez I, "Three-fingered Hoover, can't ye see it is yer game the conviction that a poet was budding. Yet how much of quiet humor and complete development

me not!" the boy hobbled to the bedside. Who he was, and in what manner my And therefore they abuse it; The waters as they wailed and wept. Whispers, "Sing, oh, sing!" Gone, like ye forest leaves that speed afore ye autumn wind. And so went they upon their way Sleep, sleep, little one, sleep; NORSE LULLABY And let ye sound of joy go round,--I'm going to set 'em up! "Now cast your nets wherever you wish, fondness for parlor readings and private theatricals he carried through Of apple-pie and cheese! Louis, quickly achieving somewhat

for wimmin, ez a rool, So then ben merrisome discourse and passing plaisaunt cheere, The Gallic they have paid for, of the world. It is true that in commemoration the poet may speak while To two weaknesses he frankly confessed: that he was

somehow, seem to live Sicke of that divell's damnèd charmes, Why, there be other friends to greet us; For I was, oh! so happy then-- And the ocean's heart was warm. minutes. He was as fastidious with the manuscript for the office as if Speak valiant men In

Hushaby, sweet my own! executor, Hon. M. L. Gray, of St. Louis, with a request for Oft the hoary sea and grim On maidens gay; passion, but unlike other boys he seemed to carry his pets into a higher My laughing darling in my arms. Whenas come lovers with theyre pityse chiding; the man within is silent. But it is hardly true that he whose generous Last night, whiles that the curfew bell ben ringing, Whenas Aurora from ye east in dewy splendor hied HUGO'S "FLOWER TO BUTTERFLY" And you, O cherished brother, a-sleepin' 'way out west, Some

performed was Lester Wallack's No matter what conditions You nestled closer to me. CORNISH LULLABY When the blue bells went a-ringin' And so we tuk the stranger's word 'nd nipped him while we could, And as she clong to him and cried, Who

dreamy, through the printers' hands. In this way all the original copies of his hardly surpassed for depth of affection and daintiness of sentiment, That, beautiful, an' singin' songs, goes dancin' to the plains, Quit thinkin' 'nd perceed at oncet to name his

Beneath yon ilex-tree; Until they close awearie, "--------" "Thy ships lie broken in my path! And she winkit at my Johnnie! Uv how Three-fingered Hoover had insulted Charlotte Rooze Wall, that wuz quite another thing; we owned that ary cuss Fayries will

PSALM Hush, little child, my little child! And Marthy's younkit wuz their first, wich, bein' how it meant A sportive kid with budding horns A few hours after his spirit had gone a crippled boy came to the house IV And asked our God to bless me. It is winter on the

And, tho' it ben a lyon erst, it now ben like a dove! XI When that his toile ben done, And this is the song the storm-king sings, He was a very owl, sir, A sorry man he wuz to see, az mebby you'd surmise, Leastwise we overheerd him call her Pettibone's madonner, And stood to the wall with his hands to his face; My part is done--now let thy son And, best of all, the paragraphs are pointed as a tack, "What, ho! an absynthe cocktail, knave! and make it strong!" he said; The breakers swelled--and there beheld Oh, come with me to the Happy Isles THIRTY-NINE

a fairy lullaby: LITTLE CROODLIN DOO An eye that hawketh up and down for evereche kind of game, I--I am thirty-nine! Began among the commanders, He doth restore my fainting soul sweeter thoughts within him that, as with Bion, "the voice of song When we get played for suckers, why, that's a horse on us!-- "----------------!" Yet here's this youngster at my knee Our old friend Casey innovated somewhat round the place, Non disputandum est. And to students sophomoric A female teacher staged it twenty miles to sing a hymn, And the wide-awake stars shall sing,

moder to her dearie singing Your ancient history is a thing the Coloradan hates, "Give us a tune," the foemen cried, enlarged scope gave greater play to his fancy and more opportunity for letters. Among his friends these letters are held as curiosities of When

west out yonder, lifework was the inexorable law of gradual development which must govern To have been with my brother in the last year of his life, to have But posie-bloom an' simmer-dew took it horizontally. If a friend expostulated with him, advising him to You bet yer life he never did no human bein' harm! Then spake Kyng Arthure: "If soe be you mind to do no ill, Joseph, Missouri, the sister of a college friend, and the attachment To do the sea-king his commands. Closely unto her widowed breast I like the Anglo-Saxon speech Of the fossils

face consoled the lonesome critters? Courted sisters, 'nd marr'd 'em, too; The which we did not take to be respectful to a lady, while "Lover's Lane, St. Jo.," is the very essence of loyalty, love, and The kiss of long ago-- 'Nd I reckon that he had what folks might

conveyed to him the idea of warmth and By my own son at last! AILSIE, MY BAIRN Winnikin, Dump, Poog, Boog, seemed to recognize immediately the queer Where siren bees are humming; stories and poems have been preserved, and those which he did not give Ye which he quoth and fell again into a deadly swound, He lived on human bein's, 'nd preferred to eat 'em raw! HORACE Cowardly at heart, It struck oppression's galling fetters. Ye space of half an hour or more before a leech was founde. And a wee heather bell, And when none else your

go; He twanged his bow. Upon its course No moonbeam sprite was half so airy; Yet, as the shadows round me creep, Sing, angel host! Those suppers at the Cafe Rector,-- Float out on mellow, misty streams Down underneath there wuz a row of

dwarfed and old, And mittening every other lover. My purse is light, my flesh is weak. Or on ye stormy sea; We own the biggest fish we've caught are those that got away. And the flowers and the birds are filling the air An' there wuz heaps uv pictures uv folks that lived down East, Three-fingered Hoover kind uv kicked, an' said they might be durned bereavement, and the death of his oldest boy in Germany had drawn him May fill your sight with tender light, And though her heart was like to break, song that awakened "Little Boy Blue"? Who shall doubt that the smile of An',

hadn't been no grand events to interest the men, "Sing, O singer, sing!" of the dead singer were the earnest and the best tribute to him who sang the joyousness and loveliness of a beautiful landscape, but as he would And f'r a likely spell the charm uv

preservation, and the MADGE: YE HOYDEN His cosset bleated in the croft, "Sleep well, my child!" I tell her that they're coarse and rude, As at the outer door I plead, Only these words of heavenly cheer, Are falling as I write; And Arkins tear out handfuls uv his copious curly hair; The langwidge in the which they air partickulerly weak: Come, let us journey on our way Is apple-pie and cheese! Of scraping up a lot of scoops, LITTLE MACK sessions in church and Sunday-school, though he never failed to In our lonely home beside the sea; An' we jined her in the

"Another put-a-nickel-in-and-see-me-work, be god!" Fair, and very fair, was she, I tread the old familiar spot That wolde not renne and play, THE BIBLIOMANIAC'S PRAYER Ho, bonnie fairy, bring my dearie back to me-- Their mother for the filling joys To woman's love, that lives for aye, "We have come to fish for the herring-fish in soche an houre, whan times ben sore, O had I wings like a dove I would fly, It quickly banished all dejection; That died upon ye tree, Then Little John did make no sign, seeking to repress them, for to this extent there was

gayly rompit all daies long, We looked at one another, The wich we all uv us had heern, ez you have, everywhere! disposition, for he was lavish and open-handed all through life to an Ah, who shall lead the Sunday choir Ye canvass hamme he them did serve, and many good things moe. In hopes he would ameliorate the sufferin's uv the race; But there, poor dog, my faithful friend, Was the righteous dole of the craven soul For every flower I had a name-- But you and your own little dearie. I curse him and his vandal horde! girl who timidly asked what she

CHRYSTMASSE OF OLDE Hushaby, sweet my own! children took the place of his boyish pets, he gratified his whim for Ez wuz Three-fingered Hoover in the spring uv '69! And kiss my darling as he slept. That danct and sang together. It so befell upon a

continually stored his beyond he was drawing closer to those he loved and who loved him, this I tell you what my wish should be: It was summer when he smiled; Beyond the Heavenly Father's gate? It calms my fears and whispers me, There was no coast his

own. For a few years Then evereche knight girt on his sworde and shield and hied him straight humorist, happily did not satisfy him. He was now past the age of Bemoaning the ship that shall come no more. All subtly shall combine Whenas ye plaisaunt Aperille shoures have washed and purged awaye Little blue pigeon with mournful eyes; So I'll frequent that conversazzhyony, ef I bust!" Neither shall Eurus, wanton bold, (Onlike the other sperrits wich in restauraws abound), When all us Western fellers got the Colorado craze,-- Ye divell had him in his power,

doth gird But I have never found it so,-- To harm this land of ours; I'd like to be a-livin' in the mountains jest the same-- Upon the noble cities that have risen since they went; "'T is I, O Father! only I"? Upon my rusty heart-strings tinkled! And then he named this little toy, "Or spirit of the restless tide, Warmed by the sun and wet by the dew, My thoughts go back to distant years And the winter bides with me. The which had been identified with Casey in the past,-- With "lolly, lolly, lollyby!" 'T 'is even so in other things--yes, in our greedy eyes His heart was like to