For ICD-9-CM, injuries are grouped together into fractures, dislocations, sprains and strains; however, for ICD-10-CM injuries will now be grouped by site. For example, all injuries to the head will be in the S00-S09 section. This chapter will now encompass two alpha characters. The S section will cover various injuries pertaining to a single body region while the T section will cover injuries to unspecified body areas as well as poisonings and other consequences of external causes.
Many fracture codes within this chapter will now include much greater specificity such as the type of fracture, laterality, delayed healing, nonunions, anatomical site and whether the fracture is displaced or not. We will also see the addition of the 7th character to identify the initial encounter, subsequent encounter, or sequela. For example the ICD-10-CM Coding Guidelines for Chapter 19 state the following:
- A - “initial encounter is used while the patient is receiving active treatment for the condition”
- D - “subsequent encounter is used for encounters after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase”
- S - “is for use for complications or conditions that arise as a direct results of a condition, such as scar formation after a burn”
As you become more familiar with this chapter, you will see that within the fracture codes there will be additional 7th characters for specific codes, such as:
- A - initial encounter for closed fractures
- B - initial encounter for open fractures
- 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 - sequela
Additionally, you will see 7th character expansion to designate the specific type of an open fracture, based on the Gustilo open fracture classification.
- B - initial encounter for open fracture type I or II
- C - initial encounter for open fracture type IIIA, IIIB, or IIIC
- 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
- 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
- M - subsequent encounter for open fracture type I or II with nonunion
- N - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
- Q - subsequent encounter for open fracture type I or II with malunion
- R - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
The ICD-10-CM Coding Guidelines for Chapter 19 specify that a fracture that is not indicated as displaced or nondisplaced should default to displaced, a fracture not designated as open should default to a closed fracture code and in the event of multiple fractures you will sequence them in accordance to the severity.
ICD-10-CM provides a higher level of specificity to look at when coding for injuries and the examples provided above are just a few. Be sure to read the entire section of these coding guidelines for additional information.
References: ICD-10-CM Official Guidelines for Coding and Reporting 2014; pg 66-75
AAPC ICD-10-CM 2013 Complete Draft Code Set
AHIMA ICD-10-CM 2014 Draft Code Book
This commentary is a summary prepared by McKesson’s Business Performance Services division and highlights certain changes, not all changes, in 2014 CPT® codes relating to the specialty of academic, multi-specialty and office based
physicians. This commentary does not supplant the American Medical Association’s current listing of CPT® codes, its documentation in the annual CPT Changes publications, and other related publications from American Medical Association, which are the authoritative source for information about CPT® codes. Please refer to your 2014 CPT® Code Book, annual CPT® Changes publication, HCPCS Book and Payer Bulletins for additional information, including additions, deletions, changes and interpretations that may not be reflected in this document.
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