INJURY CODES IN
ICD-10-CM
Training for Trauma
Registrars
7/18/14
Holly Hedegaard, MD, MSPH
1
TRAINING OVERVIEW
• General description of ICD-10-CM
• Chapter 19, Injury Diagnosis Codes
Break for Lunch
• Chapter 20, External Cause of Injury Codes
• Related codes to consider
2
ICD-10-CM
• Clinical modification of ICD-10
• First draft for public comment in 1997
• Field tested by the AHA and AHIMA in 2003
• New concepts/codes added annually through
the ICD Coordination and Maintenance
Committee at NCHS
3
WHAT’S NEW IN ICD-10-CM?
• Relevant codes for ambulatory and managed
care encounters
• Greater specificity in code assignment
• Addition of sixth and seventh characters
• Combination diagnosis/symptom codes
• Expanded injury codes
• Of the approx 70,000 codes in ICD-10-CM,
43,000 are in the injury chapters!
4
ICD-10-CM ON-LINE
http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2015
1. Scroll down to “FY 2015 release of ICD-10-CM”
2. Select “ICD-10-CM PDF Format”
3. Select “ICD10CM_FY2015_Full_PDF.zip”
4. Select “FY15_Tabular.PDF”
5. Select Chapter 19 (injury diagnosis codes) or
Chapter 20 (external cause codes)
5
GENERAL EQUIVALENCE MAPS (GEMS)
• A code to code reference dictionary for ICD -9CM and ICD-10-CM
• Offers possible acceptable translation
alternatives
• One ICD-9-CM code can be represented by
multiple ICD-10-CM codes and vice versa
• New concepts in ICD-10-CM that have no
predecessor in ICD-9-CM (e.g., underdosing,
blood type, Glasgow Coma Scale)
6
ICD-10-CM GEMS
http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2015
1. Scroll down to “FY 2015 release of ICD-10-CM”
2. Select “General Equivalence Mapping Files”
7
CHAPTER 19
INJURY DIAGNOSIS
CODES
8
SECTION OVERVIEW
• General differences between ICD-9-CM and
ICD-10-CM
• ICD-10-CM code structure
• Details for specific body regions
9
ICD-9-CM VS ICD-10-CM
FOR INJURY DIAGNOSES
Approx 2,600 codes
Approx 43,000 codes
Code range 800-959
“S” and “T” codes
3-5 characters
3-7 characters
“x” placeholder
Specificity limited
Greater specificity
No specifics on laterality
Codes for right, left, bilateral
10
ICD-9-CM VS ICD-10-CM
FOR INJURY DIAGNOSES
ICD-9-CM:
813.22
Fracture of shaft of ulna, closed
ICD-10-CM:
S52.244A
Nondisplaced spiral fracture of shaft of
ulna, right arm, initial encounter for closed
fracture
11
S52.244A
Nondisplaced spiral fracture of shaft of ulna, right
arm, initial encounter for closed fracture
Injury Chapter
12
S52.244A
Nondisplaced spiral fracture of shaft of ulna, right
arm, initial encounter for closed fracture
Major Body Region
13
S52.244A
Nondisplaced spiral fracture of shaft of ulna, right
arm, initial encounter for closed fracture
Major nature of injury
14
S52.244A
Nondisplaced spiral fracture of shaft of ulna, right
arm, initial encounter for closed fracture
Specific details on body
region and nature of injury
15
S52.244A
Nondisplaced spiral fracture of shaft of ulna, right
arm, initial encounter for closed fracture
Type of Encounter
16
CHANGE IN PRIMARY AXIS OF
INJURY DIAGNOSIS CODES
ICD-9-CM
Fractures
Dislocations
Sprains/Strains
800-829
830-839
840-848
ICD-10-CM
Injuries to head
S00-S09
Injuries to neck
Injuries to thorax
S10-S19
S20-S29
17
STRUCTURE OF INJURY DIAGNOSIS
CODES IN ICD-10-CM
Injury to:
Code Range
Head
S00-S09
Neck
S10-S19
Thorax
S20-S29
Abdomen, lower back, lumbar spine,
pelvis, and external genitals
S30-S39
Shoulder and upper arm
S40-S49
Elbow and forearm
S50-S59
Wrist, hand and fingers
S60-S69
Hip and thigh
S70-S79
Knee and lower leg
S80-S89
Ankle and foot
S90-S99
18
STRUCTURE OF INJURY DIAGNOSIS
CODES IN ICD-10-CM
Type of Injury at 3rd Character (in general)
0
1
2
Superficial injury
Open wound
Fracture
3
4
5
Dislocation and sprain
Injury of nerves
Injury of blood vessels
6
9
Injury of muscles and tendons
Other and unspecified
19
STRUCTURE OF INJURY DIAGNOSIS
CODES IN ICD-10-CM
S00 Superficial injury of head
S10 Superficial injury of neck
S20 Superficial injury of thorax
S30 Superficial injury of abdomen, lower back, and pelvis
S01
Open wound of head
S11
Open wound of neck
S21
Open wound of thorax
S31
Open wound of abdomen, lower back, and pelvis
S02
Fracture of skull and facial bones
S12
Fracture of neck
S22
Fracture of rib(s), sternum and thoracic spine
S32
Fracture of lumbar spine and pelvis
20
S52.244A
Nondisplaced spiral fracture of shaft of ulna, right
arm, initial encounter for closed fracture
Specific details on body
region and nature of injury
21
SUPERFICIAL INJURY
(3 RD CHARACTER = 0)
Specific type of superficial injury
provided in 5th character
•
•
•
•
•
•
Abrasion
Blister
Contusion
External constriction
Superficial foreign body
Insect bite (nonvenomous)
22
SUPERFICIAL INJURY
(3 RD CHARACTER = 0)
S00.211A
Abrasion of right eyelid and periocular
area, initial encounter
S = Injury Chapter
0 = Head
0 = Superficial injury
.
2 = Eyelid and periocular area
1 = Abrasion
1 = Laterality (right)
A = Initial encounter
23
OPEN WOUND
(3 RD CHARACTER = 1)
Specific type of open wound
provided in 5th character
•
•
•
•
•
Laceration w/foreign body
Laceration w/o foreign body
Puncture wound w/foreign body
Puncture wound w/o foreign body
Bite
24
OPEN WOUND
(3 RD CHARACTER = 1)
S41.031A
Puncture wound without foreign body
of right shoulder, initial encounter
S = Injury Chapter
4 = Shoulder and upper arm
1 = Open wound
.
0 = Shoulder
3 = Puncture wound w/o foreign body
1 = Laterality (right)
A = Initial encounter
25
OPEN WOUND
(3 RD CHARACTER = 1)
Specific type of open wound
provided in 5th character
S41.01
Laceration of shoulder without
foreign body
S41.02
Laceration of shoulder with
foreign body
S41.03
Puncture wound of shoulder
without foreign body body
26
FRACTURE
(3 RD CHARACTER = 2)
Specific type of fracture
provided in 5th character
•
•
•
•
•
•
•
•
Comminuted
Greenstick
Oblique
Spiral
Segmental
Torus
Transverse
Displaced vs non-displaced
27
FRACTURE
(3 RD CHARACTER = 2)
S42.312
Greenstick fx, shaft of left humerus
S42.342
Spiral fx, shaft of left humerus
S42.352
Comminuted fx, shaft of left humerus
S42.362
Segmental fx, shaft of left humeruss
28
LATERALITY
(“6 TH CHARACTER”)
S00.411
Abrasion of right ear
S81.012
Laceration without foreign body,
left knee
S22.43
Multiple fractures of ribs, bilateral
S72.336
Nondisplaced oblique fracture of
shaft of unspecified femur
29
TYPE OF ENCOUNTER
7 TH CHARACTER
A:
Initial encounter
Active treatment, ER encounter, evaluation and
treatment by new physician
D:
Subsequent encounter
Routine care during healing phase (e.g., cast
change/removal, removal of external fixation
device)
S:
Sequela
Complications or conditions that arise as a
direct result of the injury of an injury
30
TYPE OF ENCOUNTER
7 TH CHARACTER – FRACTURES
A
Initial encounter for closed fracture
B
Initial encounter for open fracture
D
Subsequent encounter for fracture with routine healing
G
Subsequent encounter for fracture with delayed healing
K
Subsequent encounter for fracture with nonunion
P
Subsequent encounter for fracture with malunion
S
Sequelae
31
TYPE OF ENCOUNTER
S52 FRACTURE OF FOREARM
A
Initial encounter for closed fracture
B
Initial encounter for open fracture type I or II
C
Initial encounter for open fracture type IIIA, IIIB, or IIIC
D
Subsequent encounter for closed fracture with routine healing
E
Subsequent encounter for open fracture type I or II with routine
healing
F
Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with
routine healing
G
Subsequent encounter for closed fracture with delayed healing
H
Subsequent encounter for open fracture type I or II with delayed
healing
J
Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with
delayed healing
etc. (7 more categories)
32
DETAILS FOR
SPECIFIC BODY REGIONS
33
HEAD (S00-S09)
Unique codes for skull fx and intracranial injury
• No combo codes as in ICD-9-CM
• Skull fx codes do not include modifier for loss of
consciousness (LOC)
• No distinction for closed vs open
• Include 7 th character for type of encounter
• A = initial encounter for closed fx
• B = initial encounter for open fx
• Include codes for any associated open wounds
(S01.-)
34
HEAD (S00-S09)
Specific codes for LeFort fx
• S02.411 LeFort I fracture
• S02.412 LeFort II fracture
• S02.413 LeFort III fracture
35
S06 INTRACRANIAL INJURY
S06.0
S06.1
S06.2
S06.3
S06.4
S06.5
S06.6
S06.8
S06.9
Concussion
Traumatic cerebral edema
Diffuse traumatic brain injury
Focal traumatic brain injury
Specific codes for right and left
Epidural hemorrhage
Traumatic subdural hemorrhage
Traumatic subarachnoid hemorrhage
Other specified intracranial injuries
Internal carotid, intracranial portion
Unspecified intracranial injury
36
S06 INTRACRANIAL INJURY
LOC MODIFIER
S06.0X Concussion
S06.0X0
Without LOC
S06.0X1
LOC 30 mins or less
S06.0X2
LOC 31 mins to 59 mins
S06.0X3
LOC 1 hr to 5 hrs 59 mins
S06.0X4
LOC 6 hrs to 24 hrs
S06.0X5
LOC>24 hrs w/return to pre-existing conscious level
S06.0X6
LOC >24 hrs w/o return to pre -existing conscious
level with pt surv iv ing
S06.0X7
LOC of any duration w/death due to TBI prior to
regaining consciousness
S06.0X8
LOC of any duration w/death due to other cause
prior to regaining consciousness
S06.0X9
With LOC of unspecified duration
37
NECK (S10-S19)
Unique codes for vertebral fracture and spinal
cord injury
• No combo codes as in ICD-9-CM
Specific codes for:
• Vertebral fracture vs spondylolisthesis
• Dislocation vs subluxation
• Minor vs major laceration of blood vessels
• Laterality of blood vessels
38
THORAX (S20-S29)
Detailed codes for fx of thoracic vertebrae
• Wedge compression, burst, unstable burst, other,
unspecified fx
• A fx not indicated as displaced vs non-displaced should
be coded to displaced
Specific codes for:
• Laterality for rib fx
• Subluxation vs dislocation of thoracic vertebrae
• Minor vs major laceration of blood vessels
• Laterality of blood vessels
• Unilateral vs bilateral injuries to lungs and bronchi
39
ABDOMEN, LOWER BACK, LUMBAR
SPINE, PELVIS, ETC. (S30-S39)
No distinction between closed vs open injuries to
organs
• Code any associated open wounds (S31.-)
Detailed codes for fx of lumbar vertebrae
• Wedge compression, burst, unstable burst,
other, unspecified fx
• A fx not indicated as displaced vs non-displaced
should be coded to displaced
40
ABDOMEN, LOWER BACK, LUMBAR
SPINE, PELVIS, ETC. (S30-S39)
Specific codes for:
• Open wound of abdomen +/- penetration into
peritoneal cavity, by quadrant
• Minor vs major laceration of blood vessels
• Injuries to ovary, fallopian tube, prostate
• Laterality of blood vessels and organs (kidney,
ovary)
41
ABDOMEN, LOWER BACK, LUMBAR
SPINE, PELVIS, ETC. (S30-S39)
Sacral fx
• 2 codes in ICD-9-CM (closed vs open fx)
• 16 codes in ICD-10-CM (Zone I-III, Type 1-4, nondisplace vs minimally displaced vs severely
displaced)
Acetabular fx
• 2 codes in ICD-9-CM (closed vs open fx)
• 54 codes in ICD-10-CM (displaced vs non-displaced,
type of fx, location, laterality)
42
INJURIES TO EXTREMITIES (S40-S99)
Extensive expansion in the number of codes for all
structures (bones, blood vessels, nerves, muscles,
tendon, joints, etc.)
e.g., Clavicle fx
• 2 codes in ICD-9-CM (closed vs open fx)
• 24 codes in ICD-10-CM (non-displaced vs
displaced, location, laterality)
e.g., Open wound of thumb
• No specific code in ICD-9-CM
• 36 codes in ICD-10-CM
43
INJURIES TO EXTREMITIES (S40-S99)
e.g., Femur fx
• “2 pages” of codes in ICD-9-CM
• “6 pages” of codes in ICD-10-CM
e.g., Injury to muscle, fascia, tendon
• “No” codes
• Extensive codes, by location and specific muscle
e.g., Unique codes for different types of injuries
to each finger and toe
44
INJURIES TO EXTREMITIES (S40-S99)
Complete coding will require very
detailed information on all
extremity injuries!
45
INJURY, POISONING AND OTHER
CONSEQUENCES OF EXTERNAL CAUSES
(T07-T88)
• Effects of foreign body entering through natural
orifice (T15-T19)
• Burns and corrosions (T20-T32)
• Distinction between thermal and chemical burns
• T31 and T32 codes for %TBSA burn, corrosion
• Frostbite (T33-T34)
• Superficial (T33) vs with tissue necrosis (T34)
46
INJURY, POISONING AND OTHER
CONSEQUENCES OF EXTERNAL CAUSES
(T07-T88)
• Poisoning by, adverse effects of and underdosing
of drugs, medicaments and biological substances
(T36-T50)
• Toxic effects of substances chiefly nonmedicinal
as to source (T51-T65)
• T63 Toxic effect of contact with venomous
animals and plants (snake bites, scorpion stings)
47
INJURY, POISONING AND OTHER
CONSEQUENCES OF EXTERNAL CAUSES
(T07-T88)
• Other and unspecified effects of external causes
(T66-T78)
• T68
Hypothermia
• T70
Effects of air pressure and water pressure
T70.2 Effects of high altitude
T70.4 Effects of high-pressure fluid injection
• T71
Asphyxiation (40+ codes)
• T75.0 Effects of lightning
• T75.1 Unspecified effects of drowning and nonfatal
submersion
48
INJURY, POISONING AND OTHER
CONSEQUENCES OF EXTERNAL CAUSES
(T07-T88)
• Other and unspecified effects of external causes
(T66-T78)
• T74 Adult and child abuse, neglect and other
maltreatment, confirmed
• T76 Adult and child abuse, neglect and other
maltreatment, suspected
49
QUESTIONS?
50
CHAPTER 20
EXTERNAL CAUSE
CODES
51
SECTION OVERVIEW
• General differences between ICD-9-CM and
ICD-10-CM
• ICD-10-CM code structure for land transport
• Details for specific external causes
52
ICD-9-CM VS ICD-10-CM
FOR EXTERNAL CAUSE
Approx 1,300 codes
Approx 7,500
“E” codes
“V, W, X, and Y” codes*
3-5 characters
3-7 characters
“x” placeholder
Includes poisoning, FB,
asphyxiation/suffocation/
strangulation, etc.
Moved to “T” codes in injury
diagnosis chapter
Child/adult
abuse/maltreatment
Included as “T” codes in
injury diagnosis chapter
*“E” codes in ICD-10-CM describe Endocrine, Metabolic and Nutritional
disorders!
53
ICD-9-CM VS ICD-10-CM
FOR EXTERNAL CAUSE
ICD-9-CM:
E888.0
Fall resulting in striking against sharp object
ICD-10-CM:
W01.110
Fall on same level from slipping, tripping and
stumbling with subsequent striking against
sharp glass
54
ICD-10-CM
EXTERNAL CAUSE OF INJURY
Category
Code Range
Transportation
V00-V99
Slipping, tripping, stumbling & falls
W00-W19
Exposure to inanimate mechanical forces
W20-W49
Exposure to animate mechanical forces
W50-W64
Accidental non-transport drowning and submersion
W65-W74
Exposure to electric current, radiation and extreme
ambient air temperature and pressure
W85-W99
Exposure to smoke, fire and flames
X00-X08
Contact with heat and hot substances
X10-X19
Exposure to forces of nature
X30-X39
Accidental exposure to other specified factors
X52-X58
55
ICD-10-CM
EXTERNAL CAUSE OF INJURY
Category
Code Range
Intentional self-harm
X71-X83
Assault
X92-Y08
Event of undetermined intent
Y21-Y33
Legal intervention, operations of war, military
operations, and terrorism
Y35-Y38
56
LAND TRANSPORT IN ICD-9-CM
• Was a motor vehicle involved?
• Where did the event occur? (public roadway?)
• Did the event involve a single MV or 2+ MV?
• What did the MV do?
•
•
•
•
Collide with something?
Lose control, rollover?
Leave roadway, re-enter and collide with 2 nd MV?
Head-on, Rear-end, T-bone, hit parked car?
• 4 th digit to identify the injured person
57
LAND TRANSPORT IN ICD-9-CM
• Was a motor vehicle involved?
• Where did the event occur? (PR vs not a PR)
• Did the event involve a single MV vs 2+ MV?
• What did the MV do?
•
•
•
•
Collide with something?
Lose control, rollover?
Leave roadway, re-enter and collide with 2 nd MV?
Head-on, Rear-end, T-bone, hit parked car?
• 4 th digit to identify the injured person
58
LAND TRANSPORT IN ICD-10-CM
V11.0
Pedal cycle driver injured in collision with
other pedal cycle in nontraffic accident
59
LAND TRANSPORT IN ICD-10-CM
V11.0
Pedal cycle driver injured in collision with
other pedal cycle in nontraffic accident
Transportation
60
LAND TRANSPORT IN ICD-10-CM
V11.0
Pedal cycle driver injured in collision with
other pedal cycle in nontraffic accident
Who was hurt?
61
LAND TRANSPORT IN ICD-10-CM
V11.0
Pedal cycle driver injured in collision with
other pedal cycle in nontraffic accident
Collision with?
62
LAND TRANSPORT IN ICD-10-CM
V11.0
Pedal cycle driver injured in collision with
other pedal cycle in nontraffic accident
Other details
63
LAND TRANSPORT
2 ND CHARACTER
Who was injured?
Pedestrian
Code Range
V00-V09
Pedal cycle rider
Motorcycle rider
Occupant of three-wheeled motor vehicle
Car occupant
V10-V19
V20-V29
V30-V39
V40-V49
Occupant of pick-up truck or van
Occupant of heavy transport vehicle
Bus occupant
V50-V59
V60-V69
V70-V79
64
LAND TRANSPORT
3RD CHARACTER
Collision with?
Pedestrian or animal
Code
0
Pedal cycle
Two- or three-wheeled motor vehicle
Car, pick-up truck, van
Heavy transport vehicle or bus
1
2
3
4
Railway train or railway vehicle
Non-motor vehicle
Fixed or stationary object
5
6
7
Non-collision
Other and unspecified motor vehicles
8
9
65
LAND TRANSPORT
4 TH AND 5 TH CHARACTERS
Other details:
• Driver, passenger, person on outside of vehicle,
unspecified
• Boarding or alighting
• Traffic vs non-traffic
• Specific vehicle types: military vehicle, SUV
66
PEDESTRIAN
Includes:
• Person changing tire on transport vehicle
• Person examining engine of vehicle broken down
in (on side of) road
Excludes:
• Fall due to non-transport collision with other
person (W03)
• Pedestrian on foot falling (slipping) on ice and
snow (W00.-)
• Struck or bumped by another person (W51)
67
PEDESTRIAN (CONVEYANCE)
Types of pedestrian conveyance
• Rolling type: Roller skates (in-line and non-inline), skateboard, non-motorized scooter,
heelies, other
• Gliding type: Ice skates, sled, other
• Flat bottomed: Snowboard, snowskis, other
• Other: wheelchair (including powered), baby
stroller, motorized mobility scooter, other
68
PEDESTRIAN (CONVEYANCE)
Excludes:
• Collision with another person without fall (W51)
• Fall due to person on foot colliding with another
person on foot (W03)
• Fall from non-moving wheelchair, nonmotorized
scooter and motorized mobility scooter without
collision(W05.-)
• Pedestrian on foot falling (slipping) on ice and
snow (W00.-)
69
CONSIDERATIONS FOR LAND
TRANSPORT ACCIDENTS
A transport accident is one in which the vehicle
involved must be moving or running or in use for
transport purposes at the time of the accident.
Use additional codes to identify:
• Airbag injury
W22.1
• Type of street or road
Y92.4• Use of cell phone and other electronic
equipment at time of crash
Y93.C-
70
OTHER LAND TRANSPORT ACCIDENTS
(V80-V89)
Who was injured?
Code
Range
Animal-rider or occupant of animal-drawn vehicle
V80
Occupant of railway train or railway vehicle
V81
Occupant of powered streetcar
V82
Occupant of special vehicle mainly used on industrial
premises
V83
Occupant of special vehicle mainly used in agriculture
V84
Occupant of special construction vehicle
V85
Occupant of special all-terrain or other off-road motor
vehicle*
V86
*Includes ambulance, fire engine, snowmobile, dune buggy, military vehicle,
71
golf cart, go-cart, dirt bike, etc.
LAND TRANSPORT (V00-V89)
“51 pages” of Land
Transportation
codes!
72
WATER TRANSPORT ACCIDENTS
(V90-94)
Code
Range
Drowning and submersion due to accident to
watercraft
V90
Other injury* due to accident to watercraft
V91
Drowning and submersion due to accident on board
watercraft, without accident to watercraft
V92
Other injury* due to accident on board watercraft,
without accident to watercraft
V93
Other and unspecified water transport accidents
V94
*Includes burn, crush, fall, hit or struck by falling object, other
73
WATER TRANSPORT ACCIDENTS
(V90-94)
Types of events
•
•
•
•
•
•
•
•
•
•
•
Watercraft overturning
Watercraft sinking
Falling or jumping from burning watercraft
Falling or jumping from crushed watercraft
Collision between watercraft and other watercraft or object
Hit or struck by falling object due to accident to watercraft
Thrown overboard by motion of watercraft
Burned by localized fire on watercraft
Heat exposure on watercraft
Explosion on watercraft
Machinery accident on watercraft
AND MORE!
74
WATER TRANSPORT ACCIDENTS
(V90-94)
Types of watercraft
•
•
•
•
•
•
•
•
•
Merchant ship
Passenger ship: Ferryboat, Ocean Liner
Fishing boat
Other powered watercraft: Hovercraft, Jet -ski
Sailboat
Canoe or kayak
Non-powered inflatable craft
Unpowered watercraft: Surfboard, Windsurfer
Water-skis
75
SLIPPING, TRIPPING, STUMBLING AND
FALLS (W00-W19)
New concepts:
• W00
Fall due to ice and snow
• W04
Fall while being carried or supported
by other person
• W16
Falling, jumping or diving into water
• W17.82 Fall from (out of) grocery cart
76
EXPOSURE TO INANIMATE MECHANICAL
FORCES (W20-W49)
Code
Range
Struck by/against object
W20-W22
Caught/crushed between objects
W23
Contact with lifting and transmission devices
W24
Contact with sharp objects
W25-W26
Contact with tools/machinery
W27-W31
Firearms
W32-W34
Explosions
W35-W40
Exposure to other inanimate mechanical forces
W42, W45,
W46, W49
77
EXPOSURE TO INANIMATE MECHANICAL
FORCES (W20-W49)
New concepts:
• W21
Striking against or struck by sports
equipment (codes for specific items)
• W22.1 Striking against or struck by automobile
airbag
• W29.4 Contact with nail gun
78
EXPOSURE TO ANIMATE MECHANICAL
FORCES (W50-W64)
Includes accidentally struck by other person
• W50
• W51
• W52
Accidental hit, strike, kick, twist, bite or
scratch by another person
Accidental striking against or bumped into
by another person
Crushed, pushed or stepped on by crowd
or human stampede
Includes injuries from contact with animals
• Cow, pig, raccoon, dolphin, sea lion, orca, shark,
crocodile, alligator, turtle, parrot, macaw, psittacines,
chicken, turkey, goose, duck, frogs
AND MORE!
79
OTHER EXTERNAL CAUSES
Similar to ICD-9-CM but with more detail
available
Remember that some external causes are
now captured in T-codes
80
GENERAL PRINCIPLES FOR ASSIGNING
EXTERNAL CAUSE
Codes for child and adult abuse
Codes for terrorism events
Codes for cataclysmic events
Codes for transport accident
All other external causes
The first-listed external cause code should correspond to the cause of
the most serious diagnosis due to an assault, accident, or self-harm,
following the order of hierarchy listed above.
81
QUESTIONS?
82
OTHER
CONSIDERATIONS
83
PLACE OF OCCURRENCE (Y92)
Code Range
Non-institutional (private) residence
Y92.0
Institutional (nonprivate) residence
Y92.1
School, other institution and public administrative area
Y92.2
Sports and athletics area
Y92.3
Street , highway and other paved roadways
Y92.4
Trade and service area
Y92.5
Industrial and construction area
Y92.6
Farm
Y92.7
Other places
Y92.8
Unspecified place
Y92.9
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ACTIVITY (Y93)
Indicates the activity the person was engaged in
when the injury occurred*
Code Range
Walking and running
Y93.0
Water and water craft
Y93.1
Ice and snow
Y93.2
Climbing, rappeling and jumping off
Y93.3
Dancing and other rhythmic movement
Y93.4
Other sports and athletics played individually
Y93.5
Other sports and athletics played as a team or group
Y93.6
Other specified sports and athletics
Y93.7
*Activity contributed to the injury event
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ACTIVITY (Y93)
Code
Range
Other cardiorespiratory exercise
Y93.A
Other muscle strengthening exercise
Y93.B
Computer technology and other electronic devices
Y93.C
Arts and crafts
Y93.D
Personal hygiene, maintenance of interior property/clothing
Y93.E
Care giving
Y93.F
Food preparation, cooking and grilling
Y93.G
Exterior property and land maintenance, building and
construction
Y93.H
Roller coasters and other types of external motion
Y93.I
Playing musical instrument
Y93.J
Animal care
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Y93.K
STATUS (Y99)
Indicates the work status of the person at the time
the event occurred
Y99.0
Civilian activity done for income or pay
Y99.1
Military activity
Y99.2
Volunteer activity
Y99.3
Other external cause status
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OTHER CONSIDERATIONS
How complete is the documentation in the
medical record?
What level of detail in coding is really
needed?
• For your trauma service?
• For the state trauma registry?
Requirements of ACS and NTDB
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OTHER CONSIDERATIONS
ICD-10-CM map to AIS
• NHTSA Request for Information
• https://www.federalregister.gov/articles/2014/06
/12/2014-13727/icd-10-cmais-mapping-software
• Comment period ends 8/11/14
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FOR MORE INFORMATION
Holly Hedegaard, MD, MSPH
National Center for Health Statistics
Office of Analysis and Epidemiology
301-458-4460
hdh6@cdc.gov
90