Finally! The long awaited 2^nd post. I’d like to thank all of those who have visited and re-visited the ICD-10-CM blog and who have been so patient. This past year seemed to be dedicated to too many other pressing issues and unfortunately the icd-10-cm blog was placed on the back burner. However, with the New Year comes a new post! Moving forward we hope to have one in deapth post each month.

Thanks again and enjoy!
 

 

ICD-10-CM: Injury, Poisoning and Certain other Consequences of External Causes

 

In the ICD-9 we think of "Accident and Injury Codes" as the 800 and 900 code sets, in the ICD-10-CM they are “S” Codes.  S codes are located in chapter 19 along with T codes (poisoning).

The full title of  chapter 19 is: Injury, Poisoning and Certain other Consequences of External Causes,
and the codes range from three digit category S00 to T88.9

 

In this post we will only be looking at the first half of this chapter. Codes will focus only on Injury and Certain other Consequences of External Causes (S codes) and we will leave poisoning codes (T codes) for another post.

 

 S Code Range: S00.00x – S99.929

         
S codes (like 800 and 900 codes)cover injuries such as:

• Traumatic Injuries by Site

• Contusions

• Open Wounds

• Crushes

• Superficial Injuries

• Fractures

• Concussions

• Avulsions / Amputations

• Dislocations/Subluxations

• Sprain/Strains

• Injuries to Multiple Body Region

• Injuries NEC and NOS

• Foreign Bodies

• Burns

• Poisonings

• Adverse Effects

• External Causes (which include):

                        ~ Effects of Radiation, Treatments, and/or Environmental Elements
                        ~ Asphyxiation

                        ~ Abuse

                        ~ Electrocution

                        ~ Neglect

                        ~ Anaphylactic Reactions

                        ~ Early Complications of Trauma

                        ~ Early Complications from Medical Care

                        ~ Adhesions

                        ~ Perforations

                        ~ “Complications”

 

 

 

Three digit categories in the ICD-10-CM are similar to three digit categories in the ICD-9 in their order (codes are usually listed starting at the top of the body and working down, and from the outside of the body inwards).

 

S code three digit categories are:

 

S00-S09: Injuries to Head

S10-S19: Injuries to Neck

S20-S29: Injuries to Thorax

S30-S39: Injuries to the abdomen, lower back, lumbar spine, pelvis and external genitals

S40-S49: Injuries to the Shoulder and Upper Arm

S50-S59: Injuries to the Elbow and Forearm

S60-S69: Injuries to the Wrist and Hand

S70-S79: Injuries to the Hip and Thigh

S80-S89: Injuries to the Knee and Lower Back

S90-S99: Injuries to the Ankle and Foot

 

Each three digit category is further divided by injury type for that specific body region

 

Example

 

The three digit category for Head Injuries are sub-divided into:

                 ~ Superficial Injury (of the head);

                 ~ Open Wound (of the head)

                ~  Fracture (of the head)

 

Then the three digit category for Neck Injuries would follow and be divided into the same way

                ~ Superficial Injury (of the neck)

                ~ Open Wound (of the neck)

                ~ Fracture  (of the neck)

 

  Most of the three digit categories listed are further sub-divided into the following injury types

        ~Superficial injury
        ~Open Wounds
        ~Fractures
        ~Dislocations / Subluxaitons 
        ~Sprains / Strains
        ~Traumatic Injuries
        ~Avulsions/Amputations
        ~Nerve Injuries
        ~Vessel Injuries
        ~Organ/Tissue Injuries
        ~Crushing injuries

Each three digit category may also include an area specific to that set of codes

 

Example: Injuries to the head include a code set for concussions

 

 

General Guidelines

 

7th digits describing the encounter are commonly required among the S codes

The 7^th digit is usually one of the following letters:

 

A – Initial Encounter

D – Subsequent Encounter

S – Sequela

 

 

When an S code only has 5 or 6 digits available to code and requires a 7^th digit encounter letter a dummy place holder “x” must be used for each space that does not already have an assigned digit

 

Examples:

S00.01xA – Abrasion of scalp, initial encounter

S03.4 xxD– Sprain of jaw, subsequent encounter

 

Excludes 1 and Excludes 2 notations are frequently used among S codes

The Exclude 1 notation indicates that any diagnosis listed beside the notation is not coded using these S  codes and cannot be coded in combination with these S codes

 

Example: For all S codes the Excludes 1 note applies : Birth Trauma (P10-P15)

 

 

The Exclude 2 notation indicates that any diagnosis listed beside the notation is not coded using these S codes, but the diagnosis may be used in combination with these S codes if it is supported by the medical record

 

 

Example: Beside contusion of the eyelid is the excludes 2 note: contusion of the eyeball

 

 

A Closer Look 

Each three digit category is subdivided into a more specific type of injury, for instance, a three digit category may depict the head, this can be subdivided into injury types like lacerations, fractures, etc. Below we discuss how each injury type may also be further divided.

 

 

Superficial injuries include:

        ~Abrasions
        ~Blisters (nonthermal)
        ~Contusions
        ~External constrictions
        ~Superficial FB
        ~Non-venomous insect bites
        ~Other Superficial bites 
        ~Superficial Injuries

 

Codes are much more specific and include much more detail

 

Example:

ICD-9-CM has a single code for an abrasion located on the cheek, ear, gum, lip, nose, or throat

910.0

The ICD-10-CM has 12 codes, a specific code for each specific location; Abrasion, initial encounter

S00.01xA – Scalp

S00.31xA – Nose

S00.411A – Right Ear

S00. 412A – Left Ear

S00.419A – Unsp. Ear

S00.511A – Lip

S00.512A – Oral Cavity

S00.81xA – Other part of head

S00.91xA – Unsp. Part of head

S10.11xA – Throat

S10.81xA – Other part of neck

S10.91xA – Unsp. Part of neck

 

 

Superficial injury codes may be looked up in the index under these terms:

        ~Injury

        ~Superficial

        ~Anatomical location

        ~Type of injury

A code or a cross-reference may be given

 

 

Example: For an abrasion of the elbow

Injury, superficial, elbow, abrasion  - see abrasion, elbow (cross-reference)

Abrasion, elbow – S50.31 -

 

 

Open Wounds
Open wounds now have specific codes for puncture wounds, they are also no longer need to be coded as complicated or not complicated

 

Code the following in addition to the wound code when appropriate:

        ~Infections

        ~Nerve injuries

        ~Muscle/tendon injuries

        ~Open Wounds

        ~Open wound codes may be specific to

        ~With FB

        ~Without FB

        ~Left

        ~Right

 

 

Examples

S01.121A – Laceration with foreign body of right eyelid and periocular area, initial encounter

S01.131D – Puncture wound without foreign body of right eyelid and periocular area, subsequent encounter

 

 

Open wounds may be referenced in the alphabetic index under:

Wound, open, anatomical location, type

A code or cross-reference may be given

 

 

Example: Wound, open, knee

S81.00-

Bite – see Bite Knee

Laceration – see Laceration Knee

Puncture – see Puncture Knee

Open Wounds

Open wounds can also be looked up in the index under:
    - Wound type, anatomical location, specifics (ex. right/left)

Example:  Laceration, Knee – S81.019
                                                            With FB – S81.029
                                                            Left – S81.012
                                                            Left w/ FB – S81.022
                                                            Right – S81.011
                                                            Right w/FB – S81.021

 

 

 

Fractures

The majority of fractures are coded according to the following rules:
        ~ A fracture not indicated as displaced or non-displaced should be coded as displaced

        ~A fracture not identified as open or closed should be coded as closed

                        (See three digit categories for individual notations)

 

Fracture codes indicate:

        ~Traumatic or non-traumatic

        ~Displaced or nondisplaced

        ~Type of fracture

        ~Specific bone

        ~Specific location on a specific bone

Almost all fracture codes require a 7^th digit encounter letter

 

 

Code Examples:

S02.110A – Type I occipital condyle fracture, initial encounter

S02.64xD – Fracture of the ramus of the mandible, subsequent encounter

S12.430A – Unspecified traumatic displaced spondylolosthesis of fifth cervical vertebra, initial encounter

S42.221D – 2-part displaced fracture of the surgical neck of the right humerus, subsequent encounter

 

 

Looking up fractures in the alphabetic index will begin by locating the term “fracture” and then the anatomical site

 

Example:  Fracture, ankle; Fracture, radius; Fracture, foot

 

Once an anatomical location is selected several options will be indented beneath that term describing fracture types

 

Example: Fracture, foot:

        ~Astragalus

        ~Calcaneus

        ~Cuboid

        ~Cuneiform

        ~Metetarsal

        ~Navicular

        ~Talus

        ~Tarsal

        ~Toe

        ~Fractures

 

Each indented term may have a code or a cross-reference specific to that location. Also, some fractures can be located by specific names but it is not that common

 

Example: Fracture, bucket handle  - See Tear, Meniscus

 

 

Dislocations / Subluxations

Dislocation and Subluxation codes are specific to weather the injury is:

        ~A dislocation or a subluxation
        ~Left or Right on bilateral body parts
        ~Anterior, posterior, or inferior
        ~Percentage of displacement
        ~Congenital or pathological

Most codes do require a 7^th digit encounter letter. It is also important to know the difference between a dislocation and a Subluxation, in order to select the correct code.

Subluxation: A partial dislocation where the articular surfaces of a joint are partially displaced

Dislocation: A more severe injury where the articular surfaces of a joint are no longer in contact

 

 

Code Examples

S43.121A – Dislocation of right acromioclavicular joint, 100%- 200% displacement, initial encounter

S43.011A – Anterior subluxation of right humerus, initial encounter

 

 

Codes can be found in the alphabetic index under either:
Dislocation, anatomical site

Subluxation, anatomical site

Codes may be given or may be further referenced by specifics

 

 
Sprains / Strains

Sprains and strains are differentiated in the ICD-10-CM more than they are in the ICD-9 so it is important to know the difference between these two as well.

Sprain: An injury to a ligament

 

Examples: Ankle; Knee; Wrist

Strain: An injury to a muscle or tendon

 

Examples: Back; Neck; Muscle unspec.

Sprain and strain codes now reference either the left or right side and may be more specific to an exact location

Example:
The ICD-9-CM

Sprain, Shoulder

840.9

 

ICD-10-CM

Sprain, Shoulder (initial encounter)

S43.401A – Rt shoulder joint

S43.402A – Lt shoulder joint

S43.409A – Unsp. Side, shoulder joint

S43.90xA – Sprain, unspec. Parts of the shoulder girdle, unspec. Side

S43.91xA – Sprain, unspec. Parts of the shoulder girdle, Rt shoulder

S43.92xA – Sprain, unspec. Parts of the shoulder girdle, Lt shoulder

 

Both sprains and strains can be referenced in the alphabetic index by their term and anatomical location

 

Example:

Sprain, Ankle – S93.409

Calcaneofibular ligament – S93.41-

Deltoid ligament – S93.42-

 

 

Injuries

Each body region has an injuries section and each injuries section is further divided by the injury type:

        ~Nerve Injury
        ~Vessel Injury
        ~Organ/Tissue Injury
        ~Crushing injury
        ~Amputations
        ~Injuries NEC and NOC

 

Many injury codes will require the 7^th digit encounter letter and Excludes 1 and 2 notations should be watched for as well.

 

 

Examples

S44.11xA – Injury of median nerve at upper arm level, right arm, initial encounter

S06.822A – Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 31 minutes to 59 minutes, initial encounter

Injuries

S27.312A – Primary blast injury of lung, bilateral, initial encounter

S47.1xxA – Crushing injury of right shoulder and upper arm, initial encounter

S68.422A – Partial traumatic amputation of left hand at wrist level, initial encounter

 

 

Injury codes can be looked up in the alphabetic index by: Injury, type, anatomical location

Example: Injury, nerve, arm

Example 2: Injury, blood vessel, femoral, artery

 

 

Injuries can also be looked up under “Injury, anatomical location, type”

Example: 
    Injury, arm -

        Blood vessel

        Contusion

        Fracture

        Lower

        Muscle

        Nerve

        Open

        Specified type NEC

        Superficial