September 18,
2006
Coding
for Injuries
For The Record
Vol. 18 No. 19 P. 48
When multiple injuries occur, a separate AHA Coding
Clinic for ICD-9-CM code should be assigned for each injury whenever
possible. There are times, however, when ICD-9-CM directs the coder
to assign a combination code, such as when a single code can completely
identify two diagnoses. For example, a patient was admitted with a fracture
of the proximal end of the tibia and fibula. ICD-9-CM directs the coder
to use code 823.02 to identify both fractures.
The coder should avoid using the nonspecific multiple
injury code to identify injuries of multiple sites. A code for multiple
injuries may be used when there is insufficient data available in the
medical record. If there is adequate information provided, the coder
should be as specific as possible. For example, if a patient is admitted
with contusions of the back, forearm, face, and abdomen, then a separate
code should be assigned for each documented site. If, however, the patient
is admitted with multiple contusions of the trunk with no further information
of affected sites documented, then multiple contusions of the trunk,
code 922.8, may be assigned.
It should be noted that superficial injuries, such as
abrasions or contusions, are not coded when associated with more severe
injuries of the same site.
When multiple injuries exist, the code for the most
severe injury, as determined by the physician, and the treatment provided
is sequenced as the principal diagnosis (AHA Coding Clinic for ICD-9-CM,
2006, first quarter, page 66).
Fractures
Fractures are classified as either open or closed. If the medical record
does not provide specificity, the fracture is classified as closed.
The following terms are descriptions of a closed fracture:
• comminuted;
• depressed;
• elevated;
• fissured;
• fracture not otherwise specified;
• greenstick;
• impacted;
• linear;
• simple;
• slipped epiphysis; and
• spiral.
The following terms describe an open fracture:
• compound;
• infected;
• missile;
• puncture; and
• with foreign body.
Coding of multiple fractures should follow the same
guidelines as coding for multiple injuries.
Concussion
A concussion results from a blow to the head severe enough to cause
a transient or prolonged alteration of consciousness, which may be followed
by amnesia, vertigo, nausea, and weak pulse. Concussion not further
specified is classified to category 850. The fourth-digit subcategory
will identify loss of consciousness, if any, and the length of time.
If the concussion is further specified as a cerebral contusion, laceration,
or hemorrhage, it is classified to categories 851-853.
A code from category 850 is not assigned with a code
from categories 851-853. Category 854 is used when the head injury is
not classifiable to categories 850-853. A closed head injury described
as a concussion is classified to the appropriate code in category 850.
“When the head injury is specified as concussion, a code from
category 854, Intracranial injury of other and unspecified nature or
code 959.01, Head injury, unspecified, is inappropriate” (AHA
Coding Clinic for ICD-9-CM, 1999, first quarter, page 10).
Patients with concussions usually recover completely within 24 to 48
hours.
Open Wounds
Open wounds such as animal bites, avulsions, cuts, lacerations, puncture
wounds, and traumatic amputations are classified to categories 870-897.
However, it excludes open wounds associated with the following:
• Burn (940.0-949.5);
• Crushing (925-929.9);
• Puncture of internal organs (860.0-869.1);
• Superficial injury (910.0-919.9); and
• That incidental to: dislocation (830.0-839.9),
fracture (800.0-829.1), internal injury (860.0-869.1), and intracranial
injury (851.0-854.1).
The fourth-digit subcategory pertaining to open wounds
may identify whether the open wound is complicated or without mention
of complication. A complicated open wound is one that includes mention
of delayed healing, delayed treatment, foreign body retention, or infection.
There is no strict definition of delayed healing or treatment. If a
patient delays seeking treatment by one week, for example, and the wound
does not seem to be healing appropriately, then the complicated code
should be used. If the coder is unsure, the physician should be asked
for clarification. The delayed treatment and healing tends to lead to
infections, which then qualifies as a complicated open wound.
Coding and sequencing for injuries are dependent on
the physician documentation in the medical record and application of
the Official Coding Guidelines for inpatient care. Also, use specific
AHA Coding Clinic for ICD-9-CM and American Medical Association CPT
Assistant references to ensure complete and accurate coding.
— This information was prepared by Audrey
Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a
business of 3M Health Information Systems, a supplier of coding and
classification systems to nearly 5,000 healthcare providers. The company
and its representatives do not assume any responsibility for reimbursement
decisions or claims denials made by providers or payors as the result
of the misuse of this coding information. More information about 3M
Health Information Systems is available at www.3mhis.com or by calling
800-367-2447.

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