Brigid T. Caffrey, BS, CCS, Clinical/Technical Editor
As preparation for the transition to ICD-10-CM continues, coders need to prepare themselves to change coding habits from using ICD-9-CM. Some particularly ingrained habits relate to diagnosis coding of injuries.
The first notable difference between ICD-9-CM and ICD-10-CM chapter 19, “Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88),” is how the injuries are now grouped. Rather than by type of injury (i.e., fracture, sprain, etc.) as in ICD-9-CM, ICD-10 is arranged first by the body region affected, then by the specific type of injury. In addition, laterality and the episode of care are identified within the ICD-10-CM diagnosis code.
The second difference is the change to the order in which the codes are assigned, not only due to the classifications, but also as a result of changes in the coding conventions. It is imperative to review the chapter for the new instructional notes and the categories or subcategories to which they pertain and understand excludes1 (“not coded here”) and excludes2 (“not included here”) definitions. The following are some examples of coding changes to note:
- Superficial injury of the head with infection: For ICD-9-CM, this injury would be listed in the alphabetic index as “Injury, superficial, head,” which leads to code category 910 Superficial injury of face, neck, and scalp, except eye, which requires a fourth digit. The applicable fourth digits are listed in the index in the table under the main term “Superficial”; the table includes the digits indicating an “infected” injury. In the tabular list, there are no instructional notes indicating to use an additional code for the infection because the code for “superficial injury, infected” already includes any infection. In ICD-10-CM, there is an instructional note under the category S00–S09 Injuries to head, to “code also for any associated infection.” The codes to report the infection are in chapter 12, “Disease of the Skin and Subcutaneous Tissue” in category L00–L08 (Infections of the skin and subcutaneous tissue). Note that this instructional note does not appear under the other superficial injury categories but only in reference to superficial injury to the head. In summary, a superficial injury to the head with an associated infection requires at least two codes in ICD-10-CM.
- Skull fracture with intracranial injury (traumatic brain injury or hemorrhage): In ICD-9-CM, a fracture of the skull is reported using a single combination code that identifies the type and site of the fracture,; whether it was with or without contusion, hemorrhage, or other or unspecified intracranial injury; and the state of consciousness from category 800–804 Fracture of skull. In ICD-10-CM, code assignment for skull fracture with intracranial injury will be more complex, as each specified injury will be coded individually. Category S02 Fracture of skull and facial bones, has an instructional note to “code also any associated intracranial injury S06.” Therefore, both a code for the skull fracture and a separate code for the intracranial injury will be assigned. The type of intracranial injuries has been grouped and expanded in ICD-10-CM. Category S06 Intracranial injury, includes concussion; traumatic cerebral edema; diffuse traumatic brain injury; focal traumatic brain injury; contusion and laceration; contusion; laceration and hemorrhage; epidural, traumatic, traumatic subdural, and traumatic subarachnoid hemorrhage; other specified intracranial injuries; injury of left internal carotid artery; intracranial portion, not elsewhere classified; other specified intracranial injury; and unspecified intracranial injury. The state of consciousness is now identified by the sixth character in the code for the intracranial injury rather than included in the skull fracture code as it was in ICD-9-CM. It is important also to note the excludes1 and excludes2 notes under subcategories S02 and S06, and also to apply the appropriate seventh character for the episode of care, noting when the placeholder X is assigned for a valid code.