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injury codes in ICD-10-CM

injury codes in ICD-10-CM. Training for Trauma Registrars 7/18/14 Holly Hedegaard, MD, MSPH. training Overview. General description of ICD-10-CM Chapter 19, Injury Diagnosis Codes Break for Lunch Chapter 20, External Cause of Injury Codes Related codes to consider. ICD-10-CM.

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injury codes in ICD-10-CM

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  1. injury codes in ICD-10-CM Training for Trauma Registrars 7/18/14 Holly Hedegaard, MD, MSPH

  2. training Overview • General description of ICD-10-CM • Chapter 19, Injury Diagnosis Codes Break for Lunch • Chapter 20, External Cause of Injury Codes • Related codes to consider

  3. ICD-10-CM • Clinical modification of ICD-10 • First draft for public comment in 1997 • Field tested by the AHA and AHIMA in 2003 • New concepts/codes added annually through the ICD Coordination and Maintenance Committee at NCHS

  4. What’s new in ICD-10-CM? • Relevant codes for ambulatory and managed care encounters • Greater specificity in code assignment • Addition of sixth and seventh characters • Combination diagnosis/symptom codes • Expanded injury codes • Of the approx 70,000 codes in ICD-10-CM, 43,000 are in the injury chapters!

  5. ICD-10-CM On-LINE http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2015 1. Scroll down to “FY 2015 release of ICD-10-CM” 2. Select “ICD-10-CM PDF Format” 3. Select “ICD10CM_FY2015_Full_PDF.zip” 4. Select “FY15_Tabular.PDF” 5. Select Chapter 19 (injury diagnosis codes) or Chapter 20 (external cause codes)

  6. general equivalence maps (GEMs) • A code to code reference dictionary for ICD-9-CM and ICD-10-CM • Offers possible acceptable translation alternatives • One ICD-9-CM code can be represented by multiple ICD-10-CM codes and vice versa • New concepts in ICD-10-CM that have no predecessor in ICD-9-CM (e.g., underdosing, blood type, Glasgow Coma Scale)

  7. ICD-10-CM GEMS http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2015 1. Scroll down to “FY 2015 release of ICD-10-CM” 2. Select “General Equivalence Mapping Files”

  8. Chapter 19 injury diagnosis codes

  9. section overview • General differences between ICD-9-CM and ICD-10-CM • ICD-10-CM code structure • Details for specific body regions

  10. ICD-9-CM VS ICD-10-CM for injury diagnoses

  11. ICD-9-CM VS ICD-10-CM for injury diagnoses ICD-9-CM: 813.22 Fracture of shaft of ulna, closed ICD-10-CM: S52.244A Nondisplaced spiral fracture of shaft of ulna, right arm, initial encounter for closed fracture

  12. S52.244A Nondisplaced spiral fracture of shaft of ulna, right arm, initial encounter for closed fracture Injury Chapter

  13. S52.244A Nondisplaced spiral fracture of shaft of ulna, right arm, initial encounter for closed fracture Major Body Region

  14. S52.244A Nondisplaced spiral fracture of shaft of ulna, right arm, initial encounter for closed fracture Major nature of injury

  15. S52.244A Nondisplaced spiral fracture of shaft of ulna, right arm, initial encounter for closed fracture Specific details on body region and nature of injury

  16. S52.244A Nondisplaced spiral fracture of shaft of ulna, right arm, initial encounter for closed fracture Type of Encounter

  17. Change in Primary axisof Injury Diagnosis Codes

  18. Structure ofInjury Diagnosis Codes IN ICD-10-CM

  19. structurEof Injury Diagnosis Codes in ICD-10-CM

  20. Structure of Injury Diagnosis Codes in ICD-10-cm

  21. S52.244A Nondisplaced spiral fracture of shaft of ulna, right arm, initial encounter for closed fracture Specific details on body region and nature of injury

  22. Superficial injury (3rd character = 0) Specific type of superficial injury provided in 5th character • Abrasion • Blister • Contusion • External constriction • Superficial foreign body • Insect bite (nonvenomous)

  23. Superficial injury (3rd character = 0) S00.211A Abrasion of right eyelid and perioculararea, initial encounter S = Injury Chapter 0 = Head 0 = Superficial injury . 2 = Eyelid and periocular area 1 = Abrasion 1 = Laterality (right) A = Initial encounter

  24. OPEN wound (3rd character = 1) Specific type of open wound provided in 5th character • Laceration w/foreign body • Laceration w/o foreign body • Puncture wound w/foreign body • Puncture wound w/o foreign body • Bite

  25. OPEN wound (3rd character = 1) S41.031A Puncture wound without foreign body of right shoulder, initial encounter S = Injury Chapter 4 = Shoulder and upper arm 1 = Open wound . 0 = Shoulder 3 = Puncture wound w/o foreign body 1 = Laterality (right) A = Initial encounter

  26. OPEN wound (3rd character = 1) Specific type of open wound provided in 5th character S41.01 Laceration of shoulder without foreign body S41.02 Laceration of shoulder with foreign body S41.03 Puncture wound of shoulder without foreign body body

  27. Fracture(3rd character = 2) Specific type of fracture provided in 5th character • Comminuted • Greenstick • Oblique • Spiral • Segmental • Torus • Transverse • Displaced vs non-displaced

  28. Fracture(3rd character = 2) S42.312 Greenstick fx, shaft of left humerus S42.342 Spiral fx, shaft of left humerus S42.352 Comminuted fx, shaft of left humerus S42.362 Segmental fx, shaft of left humeruss

  29. Laterality(“6th Character”) S00.411 Abrasion of rightear S81.012 Laceration without foreign body, left knee S22.43 Multiple fractures of ribs, bilateral S72.336Nondisplacedoblique fracture of shaft of unspecified femur

  30. Type of Encounter 7th character A: Initial encounter Active treatment, ER encounter, evaluation and treatment by new physician D: Subsequent encounter Routine care during healing phase (e.g., cast change/removal, removal of external fixation device) S: Sequela Complications or conditions that arise as a direct result of the injury of an injury

  31. Type of encounter7th character – Fractures

  32. Type of encounter S52 Fracture of forearm

  33. Details for specific body regions

  34. HEAD (S00-S09) Unique codes for skull fx and intracranial injury • No combo codes as in ICD-9-CM • Skull fx codes do not include modifier for loss of consciousness (LOC) • No distinction for closed vs open • Include 7th character for type of encounter • A = initial encounter for closed fx • B = initial encounter for open fx • Include codes for any associated open wounds (S01.-)

  35. HEAD (S00-S09) Specific codes for LeFortfx • S02.411 LeFortI fracture • S02.412 LeFortII fracture • S02.413 LeFortIII fracture

  36. S06 Intracranial injury S06.0 Concussion S06.1 Traumatic cerebral edema S06.2 Diffuse traumatic brain injury S06.3 Focal traumatic brain injury Specific codes for right and left S06.4 Epidural hemorrhage S06.5 Traumatic subdural hemorrhage S06.6 Traumatic subarachnoid hemorrhage S06.8 Other specified intracranial injuries Internal carotid, intracranial portion S06.9 Unspecified intracranial injury

  37. S06 Intracranial injuryLOC modifier S06.0X Concussion S06.0X0 Without LOC S06.0X1 LOC 30 minsor less S06.0X2 LOC 31 minsto 59 mins S06.0X3 LOC 1 hrto 5 hrs59 mins S06.0X4 LOC 6 hrsto 24 hrs S06.0X5 LOC>24 hrs w/return to pre-existing conscious level S06.0X6 LOC >24 hrs w/o return to pre-existing conscious level with pt surviving S06.0X7 LOC of any duration w/death due to TBI prior to regaining consciousness S06.0X8 LOC of any duration w/death due to other cause prior to regaining consciousness S06.0X9 With LOC of unspecified duration

  38. NECK (S10-S19) Unique codes for vertebral fracture and spinal cord injury • No combo codes as in ICD-9-CM Specific codes for: • Vertebral fracture vs spondylolisthesis • Dislocation vs subluxation • Minor vs major laceration of blood vessels • Laterality of blood vessels

  39. THORAX (S20-S29) Detailed codes for fx of thoracic vertebrae • Wedge compression, burst, unstable burst, other, unspecified fx • A fx not indicated as displaced vs non-displaced should be coded to displaced Specific codes for: • Laterality for rib fx • Subluxation vs dislocation of thoracic vertebrae • Minor vs major laceration of blood vessels • Laterality of blood vessels • Unilateral vs bilateral injuries to lungs and bronchi

  40. Abdomen, lower back, lumbar spine, pelvis, ETC. (S30-S39) No distinction between closed vs open injuries to organs • Code any associated open wounds (S31.-) Detailed codes for fx of lumbar vertebrae • Wedge compression, burst, unstable burst, other, unspecified fx • A fx not indicated as displaced vs non-displaced should be coded to displaced

  41. Abdomen, lower back, lumbar spine, pelvis, ETC. (S30-S39) Specific codes for: • Open wound of abdomen +/- penetration into peritoneal cavity, by quadrant • Minor vs major laceration of blood vessels • Injuries to ovary, fallopian tube, prostate • Laterality of blood vessels and organs (kidney, ovary)

  42. Abdomen, lower back, lumbar spine, pelvis, ETC. (S30-S39) Sacral fx • 2 codes in ICD-9-CM (closed vs open fx) • 16 codes in ICD-10-CM (Zone I-III, Type 1-4, non-displace vs minimally displaced vs severely displaced) Acetabular fx • 2 codes in ICD-9-CM (closed vs open fx) • 54 codes in ICD-10-CM (displaced vs non-displaced, type of fx, location, laterality)

  43. Injuries to Extremities (S40-S99) Extensive expansion in the number of codes for all structures (bones, blood vessels, nerves, muscles, tendon, joints, etc.) e.g., Clavicle fx • 2 codes in ICD-9-CM (closed vs open fx) • 24 codes in ICD-10-CM (non-displaced vs displaced, location, laterality) e.g., Open wound of thumb • No specific code in ICD-9-CM • 36 codes in ICD-10-CM

  44. Injuries to Extremities (S40-S99) e.g., Femur fx • “2 pages” of codes in ICD-9-CM • “6 pages” of codes in ICD-10-CM e.g., Injury to muscle, fascia, tendon • “No” codes • Extensive codes, by location and specific muscle e.g., Unique codes for different types of injuries to each finger and toe

  45. Injuries to Extremities (S40-S99) Complete coding will require very detailed information on all extremity injuries!

  46. Injury, poisoning and other consequences of external causes (T07-T88) • Effects of foreign body entering through natural orifice (T15-T19) • Burns and corrosions (T20-T32) • Distinction between thermal and chemical burns • T31 and T32 codes for %TBSA burn, corrosion • Frostbite (T33-T34) • Superficial (T33) vs with tissue necrosis (T34)

  47. Injury, poisoning and other consequences of external causes (T07-T88) • Poisoning by, adverse effects of and underdosing of drugs, medicaments and biological substances (T36-T50) • Toxic effects of substances chiefly nonmedicinal as to source (T51-T65) • T63 Toxic effect of contact with venomous animals and plants (snake bites, scorpion stings)

  48. Injury, poisoning and other consequences of external causes (T07-T88) • Other and unspecified effects of external causes (T66-T78) • T68 Hypothermia • T70 Effects of air pressure and water pressure T70.2 Effects of high altitude T70.4 Effects of high-pressure fluid injection • T71 Asphyxiation (40+ codes) • T75.0 Effects of lightning • T75.1 Unspecified effects of drowning and nonfatal submersion

  49. Injury, poisoning and other consequences of external causes (T07-T88) • Other and unspecified effects of external causes (T66-T78) • T74 Adult and child abuse, neglect and other maltreatment, confirmed • T76 Adult and child abuse, neglect and other maltreatment, suspected

  50. Questions?

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