Chapter XIX - Injury, poisoning and certain other consequences of external causes

Question 1

When coding fractures, what do the 5th character subdivisions classify?

Answer 1

0 = closed fracture (default if not known)
1 = open fracture

Question 2

How must an infected wound be coded in Chapter XIX?

Answer 2

An infected wound should be assigned the same code that would be indexed under ‘wound’ with the sub term to describe the ‘site’.

If the organism causing the infection is known, a code from B95-B98 should be assigned in addition.

Question 3

How must multiple injuries be classified when different sites and types have been documented?

Answer 3

All injuries must be recorded separately where the specific sites and types are documented.

Question 4

How must burns or corrosions of the same site with multiple degrees be coded?

Answer 4

To the most severe degree of that site.

Question 5

When can coded in Chapter XIX that classify ‘multiple injuries’ be used?

Answer 5

Only where no detail is documented about the individual sites or types of the injury

Question 6

How many external cause codes are required when multiple injuries are caused by the same event?

Answer 6

Only one, assigned directly after the final injury code

Question 7

What do the fifth characters in Chapter XIX identify?

Answer 7

• Open and closed fractures
• Intracranial injuries with or without open intracranial wound
• Internal injuries with or without open wound into cavity

Question 8

Explain the sequencing rules around skull fractures (S02.-) associated with intracranial injuries (S06.-)

Answer 8

The intracranial injury (S06.-) must be sequenced first

Question 9

How must foreign body injuries be classified?

Answer 9

According to the site where the foreign body is currently located not to the point of entry.

Question 10

How might a condition be referred to that indicates it is a postprocedural complication/disorder?

Answer 10

• postoperative complication
• postoperative disorder
• following surgery
• following a procedure

Question 11

How many different ways can postprocedural complications and disorders be coded?

Answer 11

3 different ways

Question 12

Describe the 3 ways postprocedural complications can be coded.

Answer 12

1. Use a code from T80-T88 followed by an external cause code from Y40-Y84
2. Code to a postprocedural category within the relevant body system chapter followed by an external cause code from Y40-Y84
3. Code the condition followed by the external cause code from Y40-Y84

Question 13

If there are multiple post op complications classified to T80-T88 with the same external cause, how many external cause codes are required?

Answer 13

Only one external cause code should be assigned once following all the codes from T80-T88.

Question 14

Why should clarification be saught when coding postoperative wound infections in patient’s with prosthetic devices, implants or grafts?

Answer 14

To determine if the infection is actually due to the prosthetic device itself, or genuinely of the wound site, as this will affect the code assignment.

Question 15

What are the sequencing rules when codes from postprocedural complication categories (Y40-Y84) and infectious agent categories (B95-B98) are required to be coded together?

Answer 15

The code from B95-B98 must be sequenced before the Y40-Y84 code
(T-B-U-Y)

Question 16

When is it permissable to assign a code from a postprocedural disorder category at the end of a body system chapter?

Answer 16

When the Alphabetical Index directs to a code in the postprocedural disorder category in a body system chapter not ending in .8 or .9, or where a specific standard indicates that these codes must be used.

Question 17

In ICD-10, reactions to drugs/medicines are classfied in which two ways?

Answer 17

1. Poisonings (improper use)
2. Adverse effects (proper use)

Question 18

List the alternate ways a poisoning might be described?

Answer 18

• Intoxication (except cumulative effect)
• Overdose
• Therapeutic misadventure
• Toxic effect/toxicity
• Wrong dosage given or taken
• Wrong substance given or taken (includes taking a drug originally prescribed for another person or for a previous illness)

Question 19

When a drug has more than one component, how must the components be sequenced?

Answer 19

The components must be sequenced in the order in which they appear in the drug name.

Example: Cocodaparin = Codeine phosphate and Aspirin. Codeine phosphate would be sequenced first.

Question 20

How must an adverse reaction due to the combination of taking a prescribed drug and a non-prescribed drug be coded?

Answer 20

As a poisoning by both agents.

Question 21

Where a reaction to a drug is not stated as being the result of proper or improper use, how should this be coded?

Answer 21

It must be assumed to be the result of proper use and therefore coded as an adverse effect.

Question 22

Describe how poisonings should be coded.

Answer 22

1. Substance code from Chapter XIX
2. Circumstance of the poisoning from Chapter XX
3. Manifestation or reaction, if stated in the medical record (unless it is clear this is the main condition treated andis classified outside of Chapter XVIII)