injury codes in ICD-10-CM

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Training for Trauma Registrars

7/18/14

Holly Hedegaard, MD, MSPH

INJURY CODES IN ICD-10-CM

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• 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

TRAINING OVERVIEW

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• 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

ICD-10-CM

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• 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!

WHAT’S NEW IN ICD-10-CM?

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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)

ICD-10-CM ON-LINE

http://www.cdc.gov/nchs/icd/icd10cm.htm



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• 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)

GENERAL EQUIVALENCE MAPS (GEMS)

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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”

ICD-10-CM GEMS





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CHAPTER 19 INJURY DIAGNOSIS

CODES

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• General differences between ICD-9-CM and ICD-10-CM

• ICD-10-CM code structure• Details for specific body regions

SECTION OVERVIEW

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ICD-9-CM ICD-10-CMApprox 2,600 codes Approx 43,000 codesCode range 800-959 “S” and “T” codes3-5 characters 3-7 characters

“x” placeholderSpecificity limited Greater specificityNo specifics on laterality Codes for right, left,

bilateral

ICD-9-CM VS ICD-10-CM FOR INJURY DIAGNOSES

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ICD-9-CM: 813.22Fracture of shaft of ulna, closed

ICD-10-CM: S52.244ANondisplaced spiral fracture of shaft of ulna, right arm, initial encounter

for closed fracture

ICD-9-CM VS ICD-10-CM FOR INJURY DIAGNOSES

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S52.244ANondisplaced spiral fracture of shaft of ulna, right arm, initial encounter for closed fracture

Injury Chapter

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Major Body Region

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Major nature of injury

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Specific details on body region and nature

of injury

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Type of Encounter

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ICD-9-CMFractures 800-829

Dislocations 830-839Sprains/Strains 840-848

CHANGE IN PRIMARY AXIS OF INJURY DIAGNOSIS CODES

ICD-10-CMInjuries to head S00-S09Injuries to neck S10-S19

Injuries to thorax S20-S29

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STRUCTURE OF INJURY DIAGNOSIS CODES IN ICD-10-CM

Injury to: Code Range

Head S00-S09Neck S10-S19Thorax S20-S29Abdomen, lower back, lumbar spine, pelvis, and external genitals

S30-S39

Shoulder and upper arm S40-S49Elbow and forearm S50-S59Wrist, hand and fingers S60-S69Hip and thigh S70-S79Knee and lower leg S80-S89Ankle and foot S90-S99

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STRUCTURE OF INJURY DIAGNOSIS CODES IN ICD-10-

CMType of Injury at 3rd Character (in

general)0 Superficial injury1 Open wound2 Fracture3 Dislocation and sprain4 Injury of nerves5 Injury of blood vessels6 Injury of muscles and tendons9 Other and unspecified

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S00

Superficial injury of head

S10

Superficial injury of neck

S20

Superficial injury of thorax

S30

Superficial injury of abdomen, lower back, and pelvis

STRUCTURE OF INJURY DIAGNOSIS CODES IN ICD-10-CM

S01 Open wound of headS11 Open wound of neckS21 Open wound of thoraxS31 Open wound of abdomen, lower back, and

pelvisS02 Fracture of skull and facial bonesS12 Fracture of neckS22 Fracture of rib(s), sternum and thoracic spineS32 Fracture of lumbar spine and pelvis

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Specific details on body region and nature

of injury

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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)

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SUPERFICIAL INJURY (3RD CHARACTER = 0)

S00.211A Abrasion of right eyelid and periocular area, initial encounter

S = Injury Chapter0 = Head 0 = Superficial injury.2 = Eyelid and periocular area1 = Abrasion1 = Laterality (right)A = Initial encounter

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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

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S41.031APuncture wound without foreign body of right shoulder, initial encounterS = Injury Chapter

4 = Shoulder and upper arm 1 = Open wound.0 = Shoulder3 = Puncture wound w/o foreign body1 = Laterality (right)A = Initial encounter

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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

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FRACTURE(3RD CHARACTER = 2)

Specific type of fracture provided in 5th character• Comminuted • Greenstick • Oblique • Spiral• Segmental• Torus• Transverse• Displaced vs non-displaced

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FRACTURE(3RD CHARACTER = 2)

S42.312 Greenstick fx, shaft of left humerusS42.342 Spiral fx, shaft of left humerusS42.352 Comminuted fx, shaft of left humerusS42.362 Segmental fx, shaft of left humeruss

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LATERALITY(“6TH CHARACTER”)

S00.411 Abrasion of right ear

S81.012 Laceration without foreign body, left knee

S22.43 Multiple fractures of ribs, bilateral

S72.336 Nondisplaced oblique fracture of shaft of unspecified femur

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TYPE OF ENCOUNTER 7TH CHARACTER

A: Initial encounterActive treatment, ER encounter, evaluation and treatment by new physician

D: Subsequent encounterRoutine care during healing phase (e.g., cast change/removal, removal of external fixation device)

S: SequelaComplications or conditions that arise as a direct result of the injury of an injury

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TYPE OF ENCOUNTER7TH CHARACTER – FRACTURES

A Initial encounter for closed fractureB Initial encounter for open fractureD Subsequent encounter for fracture with routine

healingG Subsequent encounter for fracture with delayed

healingK Subsequent encounter for fracture with nonunionP Subsequent encounter for fracture with malunionS Sequelae

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TYPE OF ENCOUNTER S52 FRACTURE OF FOREARM

A Initial encounter for closed fractureB Initial encounter for open fracture type I or IIC Initial encounter for open fracture type IIIA, IIIB, or IIICD Subsequent encounter for closed fracture with routine

healingE Subsequent encounter for open fracture type I or II with

routine healingF Subsequent encounter for open fracture type IIIA, IIIB, or IIIC

with routine healingG Subsequent encounter for closed fracture with delayed

healingH Subsequent encounter for open fracture type I or II with

delayed healingJ Subsequent encounter for open fracture type IIIA, IIIB, or IIIC

with delayed healingetc. (7 more categories)

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DETAILS FOR SPECIFIC BODY REGIONS

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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.-)

HEAD (S00-S09)

Specific codes for LeFort fx• S02.411 LeFort I fracture• S02.412 LeFort II fracture• S02.413 LeFort III fracture

HEAD (S00-S09)

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S06.0 ConcussionS06.1 Traumatic cerebral edemaS06.2 Diffuse traumatic brain injuryS06.3 Focal traumatic brain injury

Specific codes for right and leftS06.4 Epidural hemorrhageS06.5 Traumatic subdural hemorrhageS06.6 Traumatic subarachnoid hemorrhageS06.8 Other specified intracranial injuries

Internal carotid, intracranial portionS06.9 Unspecified intracranial injury

S06 INTRACRANIAL INJURY

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S06.0X ConcussionS06.0X0 Without LOCS06.0X1 LOC 30 mins or lessS06.0X2 LOC 31 mins to 59 minsS06.0X3 LOC 1 hr to 5 hrs 59 minsS06.0X4 LOC 6 hrs to 24 hrsS06.0X5 LOC>24 hrs w/return to pre-existing conscious levelS06.0X6 LOC >24 hrs w/o return to pre-existing conscious level with pt survivingS06.0X7 LOC of any duration w/death due to TBI prior to regaining consciousnessS06.0X8 LOC of any duration w/death due to other cause prior to regaining consciousnessS06.0X9 With LOC of unspecified duration

S06 INTRACRANIAL INJURYLOC MODIFIER

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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

NECK (S10-S19)

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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

THORAX (S20-S29)

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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

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)


(S30-S39)

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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)


(S30-S39)

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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

INJURIES TO EXTREMITIES (S40-S99)

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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


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Complete coding will require very detailed information on

all extremity injuries!


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• 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)

INJURY, POISONING AND OTHER CONSEQUENCES OF EXTERNAL

CAUSES (T07-T88)

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• 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)


CAUSES (T07-T88)

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• 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


CAUSES (T07-T88)

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• 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


CAUSES (T07-T88)

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QUESTIONS?

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CHAPTER 20 EXTERNAL CAUSE

CODES

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• General differences between ICD-9-CM and ICD-10-CM

• ICD-10-CM code structure for land transport

• Details for specific external causes

SECTION OVERVIEW

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ICD-9-CM ICD-10-CMApprox 1,300 codes Approx 7,500“E” codes “V, W, X, and Y” codes*3-5 characters 3-7 characters

“x” placeholderIncludes poisoning, FB, asphyxiation/suffocation/strangulation, etc.

Moved to “T” codes in injury diagnosis chapter

Child/adult abuse/maltreatment

Included as “T” codes in injury diagnosis chapter

ICD-9-CM VS ICD-10-CM FOR EXTERNAL CAUSE

*“E” codes in ICD-10-CM describe Endocrine, Metabolic and Nutritional disorders!

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ICD-9-CM: E888.0Fall resulting in striking against sharp

object

ICD-10-CM: W01.110Fall on same level from slipping,

tripping and stumbling with subsequent striking against sharp

glass

ICD-9-CM VS ICD-10-CM FOR EXTERNAL CAUSE

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Category Code Range

Transportation V00-V99Slipping, tripping, stumbling & falls W00-W19Exposure to inanimate mechanical forces W20-W49Exposure to animate mechanical forces W50-W64Accidental non-transport drowning and submersion

W65-W74

Exposure to electric current, radiation and extreme ambient air temperature and pressure

W85-W99

Exposure to smoke, fire and flames X00-X08Contact with heat and hot substances X10-X19Exposure to forces of nature X30-X39Accidental exposure to other specified factors X52-X58

ICD-10-CM EXTERNAL CAUSE OF INJURY

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Category Code Range

Intentional self-harm X71-X83Assault X92-Y08Event of undetermined intent Y21-Y33Legal intervention, operations of war, military operations, and terrorism

Y35-Y38

ICD-10-CM EXTERNAL CAUSE OF INJURY

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• Was a motor vehicle involved?• Where did the event occur? (public roadway?)• Did the event involve a single MV or 2+ MV?• What did the MV do?• Collide with something?• Lose control, rollover?• Leave roadway, re-enter and collide with 2nd

MV?• Head-on, Rear-end, T-bone, hit parked car?

• 4th digit to identify the injured person

LAND TRANSPORT IN ICD-9-CM

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• Was a motor vehicle involved?• Where did the event occur? (PR vs not a PR)• Did the event involve a single MV vs 2+ MV?• What did the MV do?• Collide with something?• Lose control, rollover?• Leave roadway, re-enter and collide with 2nd

MV?• Head-on, Rear-end, T-bone, hit parked car?

• 4th digit to identify the injured person


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V11.0Pedal cycle driver injured in collision with other pedal cycle in nontraffic

accident


60


accident


Transportation

61


accident


Who was hurt?

62


accident


Collision with?

63


accident

Other details


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Who was injured? Code Range

Pedestrian V00-V09Pedal cycle rider V10-V19Motorcycle rider V20-V29Occupant of three-wheeled motor vehicle

V30-V39

Car occupant V40-V49Occupant of pick-up truck or van V50-V59Occupant of heavy transport vehicle V60-V69Bus occupant V70-V79

LAND TRANSPORT2ND CHARACTER

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Collision with? Code Pedestrian or animal 0Pedal cycle 1Two- or three-wheeled motor vehicle 2Car, pick-up truck, van 3Heavy transport vehicle or bus 4Railway train or railway vehicle 5Non-motor vehicle 6Fixed or stationary object 7Non-collision 8Other and unspecified motor vehicles 9

LAND TRANSPORT3RD CHARACTER

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Other details:• Driver, passenger, person on outside of

vehicle, unspecified• Boarding or alighting• Traffic vs non-traffic• Specific vehicle types: military vehicle,

SUV

LAND TRANSPORT4TH AND 5TH CHARACTERS

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Includes:• Person changing tire on transport vehicle• Person examining engine of vehicle broken

down in (on side of) road

Excludes:• Fall due to non-transport collision with other

person (W03)• Pedestrian on foot falling (slipping) on ice

and snow (W00.-)• Struck or bumped by another person (W51)

PEDESTRIAN

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Types of pedestrian conveyance• Rolling type: Roller skates (in-line and

non-in-line), skateboard, non-motorized scooter, heelies, other

• Gliding type: Ice skates, sled, other• Flat bottomed: Snowboard, snowskis,

other• Other: wheelchair (including powered),

baby stroller, motorized mobility scooter, other

PEDESTRIAN (CONVEYANCE)

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Excludes:• Collision with another person without fall

(W51)• Fall due to person on foot colliding with

another person on foot (W03)• Fall from non-moving wheelchair,

nonmotorized scooter and motorized mobility scooter without collision(W05.-)

• Pedestrian on foot falling (slipping) on ice and snow (W00.-)

PEDESTRIAN (CONVEYANCE)

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A transport accident is one in which the vehicle involved must be moving or running or in use for transport purposes at the time of the accident.

Use additional codes to identify:• Airbag injury W22.1• Type of street or road Y92.4-• Use of cell phone and other electronic

equipment at time of crash Y93.C-

CONSIDERATIONS FOR LAND TRANSPORT ACCIDENTS

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Who was injured? Code Rang

eAnimal-rider or occupant of animal-drawn vehicle

V80

Occupant of railway train or railway vehicle V81Occupant of powered streetcar V82Occupant of special vehicle mainly used on industrial premises

V83

Occupant of special vehicle mainly used in agriculture

V84

Occupant of special construction vehicle V85Occupant of special all-terrain or other off-road motor vehicle*

V86

OTHER LAND TRANSPORT ACCIDENTS (V80-V89)

*Includes ambulance, fire engine, snowmobile, dune buggy, military vehicle, golf cart, go-cart, dirt bike, etc.

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LAND TRANSPORT (V00-V89)

“51 pages” of Land

Transportation codes!

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Code Rang

eDrowning and submersion due to accident to watercraft

V90

Other injury* due to accident to watercraft V91Drowning and submersion due to accident on board watercraft, without accident to watercraft

V92

Other injury* due to accident on board watercraft, without accident to watercraft

V93

Other and unspecified water transport accidents

V94

WATER TRANSPORT ACCIDENTS

(V90-94)

*Includes burn, crush, fall, hit or struck by falling object, other

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Types of events• Watercraft overturning• Watercraft sinking• Falling or jumping from burning watercraft• Falling or jumping from crushed watercraft• Collision between watercraft and other watercraft or

object• Hit or struck by falling object due to accident to watercraft• Thrown overboard by motion of watercraft• Burned by localized fire on watercraft • Heat exposure on watercraft• Explosion on watercraft • Machinery accident on watercraftAND MORE!


(V90-94)

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Types of watercraft• Merchant ship• Passenger ship: Ferryboat, Ocean Liner• Fishing boat• Other powered watercraft: Hovercraft, Jet-

ski• Sailboat• Canoe or kayak• Non-powered inflatable craft• Unpowered watercraft: Surfboard,

Windsurfer• Water-skis


(V90-94)

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New concepts:• W00 Fall due to ice and snow• W04 Fall while being carried or supported

by other person• W16 Falling, jumping or diving into water• W17.82 Fall from (out of) grocery cart

SLIPPING, TRIPPING, STUMBLING AND FALLS (W00-

W19)

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Code Range

Struck by/against object W20-W22Caught/crushed between objects W23Contact with lifting and transmission devices W24Contact with sharp objects W25-W26Contact with tools/machinery W27-W31Firearms W32-W34Explosions W35-W40Exposure to other inanimate mechanical forces

W42, W45, W46, W49

EXPOSURE TO INANIMATE MECHANICAL FORCES (W20-

W49)

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New concepts:• W21 Striking against or struck by sports

equipment (codes for specific items)

• W22.1 Striking against or struck by automobile airbag

• W29.4 Contact with nail gun

EXPOSURE TO INANIMATE MECHANICAL FORCES (W20-

W49)

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Includes accidentally struck by other person• W50 Accidental hit, strike, kick, twist, bite or

scratch by another person• W51 Accidental striking against or bumped into by

another person• W52 Crushed, pushed or stepped on by crowd or

human stampede

Includes injuries from contact with animals• Cow, pig, raccoon, dolphin, sea lion, orca, shark,

crocodile, alligator, turtle, parrot, macaw, psittacines, chicken, turkey, goose, duck, frogs

AND MORE!

EXPOSURE TO ANIMATE MECHANICAL FORCES (W50-

W64)

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Similar to ICD-9-CM but with more detail available

Remember that some external causes are now captured in T-codes

OTHER EXTERNAL CAUSES

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Codes for child and adult abuse

Codes for terrorism events

Codes for cataclysmic events

Codes for transport accident

All other external causes

GENERAL PRINCIPLES FOR ASSIGNING EXTERNAL CAUSE

The first-listed external cause code should correspond to the cause of the most serious diagnosis due to an assault, accident, or self-harm, following the order of hierarchy listed above.

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QUESTIONS?

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OTHER CONSIDERATIONS

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PLACE OF OCCURRENCE (Y92)

Code Range

Non-institutional (private) residence Y92.0Institutional (nonprivate) residence Y92.1School, other institution and public administrative area

Y92.2

Sports and athletics area Y92.3Street , highway and other paved roadways Y92.4Trade and service area Y92.5Industrial and construction area Y92.6Farm Y92.7Other places Y92.8Unspecified place Y92.9

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Indicates the activity the person was engaged in when the injury occurred*

ACTIVITY (Y93)

*Activity contributed to the injury event

Code Range

Walking and running Y93.0Water and water craft Y93.1Ice and snow Y93.2Climbing, rappeling and jumping off Y93.3Dancing and other rhythmic movement Y93.4Other sports and athletics played individually

Y93.5

Other sports and athletics played as a team or group

Y93.6

Other specified sports and athletics Y93.7

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ACTIVITY (Y93)Code

RangeOther cardiorespiratory exercise Y93.AOther muscle strengthening exercise Y93.BComputer technology and other electronic devices Y93.CArts and crafts Y93.DPersonal hygiene, maintenance of interior property/clothing

Y93.E

Care giving Y93.FFood preparation, cooking and grilling Y93.GExterior property and land maintenance, building and construction

Y93.H

Roller coasters and other types of external motion Y93.IPlaying musical instrument Y93.JAnimal care Y93.K

87

Indicates the work status of the person at the time the event occurred

Y99.0 Civilian activity done for income or payY99.1 Military activityY99.2 Volunteer activityY99.3 Other external cause status

STATUS (Y99)

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How complete is the documentation in the medical record?

What level of detail in coding is really needed?• For your trauma service?• For the state trauma registry?

Requirements of ACS and NTDB


ICD-10-CM map to AIS• NHTSA Request for Information• https://

www.federalregister.gov/articles/2014/06/12/2014-13727/icd-10-cmais-mapping-software

• Comment period ends 8/11/14


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https://www.federalregister.gov/articles/2014/06/12/2014-13727/icd-10-cmais-mapping-software




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FOR MORE INFORMATION

Holly Hedegaard, MD, MSPHNational Center for Health

StatisticsOffice of Analysis and

[email protected]

Documents

injury codes in ICD-10-CM