Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88) Flashcards
19.a. Application of 7th Characters in Chapter 19
Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)
a. Application of 7th Characters in Chapter 19
Most categories in chapter 19 have a 7th character requirement for each applicable code. Most categories in this chapter have three 7th character values (with the exception of fractures): A, initial encounter, D, subsequent encounter and S, sequela. Categories for traumatic fractures have additional 7th character values. While the patient may be seen by a new or different provider over the course of treatment for an injury, assignment of the 7th character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time.
For complication codes, active treatment refers to treatment for the condition described by the code, even though it may be related to an earlier precipitating problem. For example, code T84.50XA, Infection and inflammatory reaction due to unspecified internal joint prosthesis, initial encounter, is used when active treatment is provided for the infection, even though the condition relates to the prosthetic device, implant or graft that was placed at a previous encounter.
7th character “A”, initial encounter is used for each encounter where the patient is receiving active treatment for the condition.
7th character “D” subsequent encounter is used for encounters after the patient has completed active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase.
The aftercare Z codes should not be used for aftercare for conditions such as injuries or poisonings, where 7th characters are provided to identify subsequent care. For example, for aftercare of an injury, assign the acute injury code with the 7th character “D” (subsequent encounter).
7th character “S”, sequela, is for use for complications or conditions that arise as a direct result of a condition, such as scar formation after a burn. The scars are sequelae of the burn. When using 7th character “S”, it is necessary to use both the injury code that precipitated the sequela and the code for the sequela itself. The “S” is added only to the injury code, not the sequela code. The 7th character “S” identifies the injury responsible for the sequela. The specific type of sequela (e.g. scar) is sequenced first, followed by the injury code.
See Section I.B.10 Sequelae, (Late Effects)
19.b. Coding of Injuries
Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)
b. Coding of Injuries
When coding injuries, assign separate codes for each injury unless a combination code is provided, in which case the combination code is assigned. Code T07, Unspecified multiple injuries should not be assigned in the inpatient setting unless information for a more specific code is not available. Traumatic injury codes (S00-T14.9) are not to be used for normal, healing surgical wounds or to identify complications of surgical wounds.
The code for the most serious injury, as determined by the provider and the focus of treatment, is sequenced first.
1) Superficial injuries
Superficial injuries such as abrasions or contusions are not coded when associated with more severe injuries of the same site.
2) Primary injury with damage to nerves/blood vessels
When a primary injury results in minor damage to peripheral nerves or blood vessels, the primary injury is sequenced first with additional code(s) for injuries to nerves and spinal cord (such as category S04), and/or injury to blood vessels (such as category S15). When the primary injury is to the blood vessels or nerves, that injury should be sequenced first.
19.c. Coding of Traumatic Fractures
1) Initial vs. Subsequent Encounter for Fractures
Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)
1) Initial vs. Subsequent Encounter for Fractures
Traumatic fractures are coded using the appropriate 7th character for initial encounter (A, B, C) for each encounter where the patient is receiving active treatment for the fracture. The appropriate 7th character for initial encounter should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion.
Fractures are coded using the appropriate 7th character for subsequent care for encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase.
Care for complications of surgical treatment for fracture repairs during the healing or recovery phase should be coded with the appropriate complication codes.
Care of complications of fractures, such as malunion and nonunion, should be reported with the appropriate 7th character for subsequent care with nonunion (K, M, N,) or subsequent care with malunion (P, Q, R).
Malunion/nonunion: The appropriate 7th character for initial encounter should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion.
The open fracture designations in the assignment of the 7th character for fractures of the forearm, femur and lower leg, including ankle are based on the Gustilo open fracture classification. When the Gustilo classification type is not specified for an open fracture, the 7th character for open fracture type I or II should be assigned (B, E, H, M, Q).
A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone.
See Section I.C.13. Osteoporosis.
The aftercare Z codes should not be used for aftercare for traumatic fractures. For aftercare of a traumatic fracture, assign the acute fracture code with the appropriate 7th character.
19.c. Coding of Traumatic Fractures
2) Multiple fractures sequencing
Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)
2) Multiple fractures sequencing
Multiple fractures are sequenced in accordance with the severity of the fracture
19.d. Coding of Burns and Corrosions
Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)
d. Coding of Burns and Corrosions The ICD-10-CM makes a distinction between burns and corrosions. The burn codes are for thermal burns, except sunburns, that come from a heat source, such as a fire or hot appliance. The burn codes are also for burns resulting from electricity and radiation. Corrosions are burns due to chemicals. The guidelines are the same for burns and corrosions. Current burns (T20-T25) are classified by depth, extent and by agent (X code). Burns are classified by depth as first degree (erythema), second degree (blistering), and third degree (full-thickness involvement). Burns of the eye and internal organs (T26-T28) are classified by site, but not by degree.
19.d. Coding of Burns and Corrosions
1) Sequencing of burn and related condition codes
Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)
1) Sequencing of burn and related condition codes
Sequence first the code that reflects the highest degree of burn when more than one burn is present.
a. When the reason for the admission or encounter is for treatment of external multiple burns, sequence first the code that reflects the burn of the highest degree.
b. When a patient has both internal and external burns, the circumstances of admission govern the selection of the principal diagnosis or first-listed diagnosis.
c. When a patient is admitted for burn injuries and other related conditions such as smoke inhalation and/or respiratory failure, the circumstances of admission govern the selection of the principal or first-listed diagnosis
19.d. Coding of Burns and Corrosions
2) Burns of the same local site
Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)
2) Burns of the same local site
Classify burns of the same local site (three-character category level, T20-T28) but of different degrees to the subcategory identifying the highest degree recorded in the diagnosis.
19.d. Coding of Burns and Corrosions
3) Non-healing burns
Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)
3) Non-healing burns
Non-healing burns are coded as acute burns.
Necrosis of burned skin should be coded as a non-healed burn.
19.d. Coding of Burns and Corrosions
4) Infected Burn
Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)
4) Infected Burn
For any documented infected burn site, use an additional code for the infection.
19.d. Coding of Burns and Corrosions
5) Assign separate codes for each burn site
Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)
5) Assign separate codes for each burn site
When coding burns, assign separate codes for each burn site. Category T30, Burn and corrosion, body region unspecified is extremely vague and should rarely be used.
19.d. Coding of Burns and Corrosions
6) Burns and Corrosions Classified According to Extent of Body Surface Involved
Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)
6) Burns and Corrosions Classified According to Extent of Body Surface Involved
Assign codes from category T31, Burns classified according to extent of body surface involved, or T32, Corrosions classified according to extent of body surface involved, when the site of the burn is not specified or when there is a need for additional data. It is advisable to use category T31 as additional coding when needed to provide data for evaluating burn mortality, such as that needed by burn units. It is also advisable to use category T31 as an additional code for reporting purposes when there is mention of a third-degree burn involving 20 percent or more of the body surface.
Categories T31 and T32 are based on the classic “rule of nines” in estimating body surface involved: head and neck are assigned nine percent, each arm nine percent, each leg 18 percent, the anterior trunk 18 percent, posterior trunk 18 percent, and genitalia one percent. Providers may change these percentage assignments where necessary to accommodate infants and children who have proportionately larger heads than adults, and patients who have large buttocks, thighs, or abdomen that involve burns.
19.d. Coding of Burns and Corrosions
7) Encounters for treatment of sequela of burns
Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)
7) Encounters for treatment of sequela of burns
Encounters for the treatment of the late effects of burns or corrosions (i.e., scars or joint contractures) should be coded with a burn or corrosion code with the 7th character “S” for sequela.
19.d. Coding of Burns and Corrosions
8) Sequelae with a late effect code and current burn
Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)
8) Sequelae with a late effect code and current burn
When appropriate, both a code for a current burn or corrosion with 7th character “A” or “D” and a burn or corrosion code with 7th character “S” may be assigned on the same record (when both a current burn and sequelae of an old burn exist). Burns and corrosions do not heal at the same rate and a current healing wound may still exist with sequela of a healed burn or corrosion.
See Section I.B.10 Sequela (Late Effects)
19.d. Coding of Burns and Corrosions
9) Use of an external cause code with burns and corrosions
Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)
9) Use of an external cause code with burns and corrosions
An external cause code should be used with burns and corrosions to identify the source and intent of the burn, as well as the place where it occurred.
19.e. Adverse Effects, Poisoning, Underdosing and Toxic Effects
Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)
Codes in categories T36-T65 are combination codes that include the substance that was taken as well as the intent. No additional external cause code is required for poisonings, toxic effects, adverse effects and underdosing codes.