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Coding Personal Injuries and Accidents in ICD-10

by | May 24, 2018 | Medical Coding News, Resources | 0 comments

Injuries are coded from Chapter 19 of ICD-10 titled “Injury, Poisoning, and Certain Other Consequences of External Causes” (codes S00-T88). These codes make up over 50% of all ICD-10 codes. While section S provides codes for the various types of injuries related to single body regions, section T covers injuries to unspecified body regions as well as poisonings and certain other consequences of external causes. As expert coders in medical coding companies know, specificity is the key to proper billing and coding of personal accidents and injuries in ICD-10. For coders to assign the most accurate codes, physicians will need to include the maximum amount of information in the medical record.

  • ICD-10 Codes for Injuries

    In ICD-10, injuries such as fractures, dislocations, and sprains and strains are categorized by the affected body part rather than the type of injury. There are multiple codes for minor injuries of almost every body area. All injuries to a region of the body are grouped by site such as injuries to the ankle, foot and toes (S90-S99), injuries to the wrist, hand and fingers (S60-S69), and injuries to the neck (S10-S19).

    Injury, poisoning and certain other consequences of external causes – Codes S00-T88

    S00-S09 Injuries to the head
    S10-S19 Injuries to the neck
    S20-S29 Injuries to the 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, hand and fingers
    S70-S79 Injuries to the hip and thigh
    S80-S89 Injuries to the knee and lower leg
    S90-S99 Injuries to the ankle and foot
    T07-T07 Injuries involving multiple body regions
    T14-T14 Injury of unspecified body region
    T15-T19 Effects of foreign body entering through natural orifice
    T20-T25 Burns and corrosions of external body surface, specified by site
    T26-T28 Burns and corrosions confined to eye and internal organs
    T30-T32 Burns and corrosions of multiple and unspecified body regions
    T33-T34 Frostbite
    T36-T50 Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances
    T51-T65 Toxic effects of substances chiefly nonmedicinal as to source
    T66-T78 Other and unspecified effects of external causes
    T79-T79 Certain early complications of trauma
    T80-T88 Complications of surgical and medical care, not elsewhere classified

  • Structure of ICD-10 Injury Codes

    The structure of ICD-10 injury codes is defined by location, laterality, and the seventh character extender. The locations of injuries described in ICD-10 are specific and, may include codes for the right and left body part. If there is a fracture, the code also defines which part of the bone is injured. The seventh character extender defines the episode of care — A – initial care, D -subsequent encounter, and S – sequel, that is:

    A – Initial encounter means the patient is receiving active treatment for the injury (e.g., surgery, emergency room treatment, or evaluation and treatment by a new medical professional).

    D – Subsequent encounter indicates that the patient is receiving routine care for the injury during the healing or recovery phase (e.g., cast removal, medication adjustment).

    S – Sequela indicates that condition or complications that arise as a result of the injury for which the patient is seeking treatment (e.g. chronic back pain after an accident).

    The ICD 10 coding scheme for reporting injury is as follows:

    • First three characters: General category
    • Fourth character: The type of injury
    • Fifth character: Which body part was injured
    • Sixth character: Which hand was injured
    • Seventh character: The type of encounter (A, D, or S)
  • External Causes of Morbidity (Codes V00-Y99) to Indicate Cause of Injury

    Secondary code(s) from Chapter 20, External causes of morbidity (codes V00-Y99) should be used with the codes from Chapter 19 to indicate cause of injury. External cause of morbidity codes provide additional information such as how the injury occurred, the intent, the place it occurred and the status of the patient at the time of the injury. Codes V00-Y99 allow classification of environmental events and circumstances as the cause of injury, and other adverse effects. Some major categories of E codes include:

    • transport accidents
    • poisoning and adverse effects of drugs, medicinal substances and biologicals
    • accidental falls
    • accidents caused by fire and flames
    • accidents due to natural and environmental factors
    • late effects of accidents, assaults or self injury
    • assaults or purposely inflicted injury
    • suicide or self inflicted injury

    There are thousands of codes in this section,including some bizarre ones:

    V97.33XD Sucked into jet engine, subsequent encounter.
    V00.01XD Pedestrian on foot injured in collision with roller-skater, subsequent encounter
    W55.41XA Bitten by pig, initial encounter.
    W61.62XD Struck by duck, subsequent encounter.
    Z63.1 Problems in relationship with in-laws

    In 2018, the following new codes were added to this section:

    V86.25 Person on outside of 3- or 4- wheeled all-terrain vehicle (ATV) injured in traffic accident
    V86.26Person on outside of dirt bike or motor/cross bike injured in traffic accident
    V86.35 Unspecified occupant of 3- or 4- wheeled all-terrain vehicle (ATV) injured in traffic accident
    V86.36 Unspecified occupant of dirt bike or motor/cross bike injured in traffic accident

    Though it is not mandatory to report these codes, they should be reported if this information is available. However, codes within the T section that include the external cause do not require an additional external cause code.

  • Capturing Personal Injuries in ICD-10 – Examples

    To code for the initial encounter of an injury to the highest level of specificity, the provider must document the external cause, place of occurrence, activity code, and external cause status. An AAPC article provides the following example to illustrate this:Example 1: Fall from balcony

    A 30-year-old woman presents to the ED for an initial visit for treatment of displaced transverse fracture left tibia. The patient was on the balcony of her home. She was leaning against the railing, the railing broke, and the patient fell.
    The documentation indicates the external cause as well as the place of occurrence, but not the activity or the external cause status. This example would be coded:
    Injury code: S82.222A
    External cause code: W13.0XXA Fall from, out of or through balcony, initial encounter
    Place of occurrence code: Y92.018 Other place in single-family (private) house as the place of occurrence of the external cause

    Example 2: Fall on or from other playground equipment

    This coding example provided by CMS describes left knee strain that occurred on a private recreational playground when a child jumped off of a trampoline and landed incorrectly. Here, the activity is also specified.
    Injury code: S86.812A, Strain of other muscle(s) and tendon(s) at lower leg level, left leg, initial encounter
    External cause code: W09.8XXA, Fall on or from other playground equipment, initial encounter
    Place of occurrence code: Y92.838, Other recreation area as the place of occurrence of the external cause
    Activity code: Y93.44, Activities involving rhythmic movement, trampoline jumping

Reporting Injuries and Accidents – Key Guidelines

  • The factors to ensure specificity while reporting a patient’s injury are: episode of care, injury site, etiology, and place of occurrence.
  • Clinicians should precisely document the details surrounding the injury in the medical record. This detail will allow medical coding service provider to add the Chapter 20 code if payers require external cause codes.
  • Verify specific coding and billing requirements with the personal injury insurance

Good documentation of injuries goes a long way in supporting personal injury claims. Experienced medical billing and coding companies work with physicians to ensure complete and precise documentation and accurate claim submission for maximum reimbursement.