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Book Excerpt: ICD-10 tips for documentation of injuries

The Clinical Documentation Improvement Specialist’s Guide to ICD-10

The Clinical Documentation Improvement Specialist’s Guide to ICD-10

The draft ICD-10-CM Official Guidelines for Coding and Reporting state that “traumatic injury codes (S00-T14.9) are not to be used for normal, healing surgical wounds or to identify complications of surgical wounds.” the tabular list note at the beginning of the Injury, Poisoning and Certain other Consequences of External Causes (S00-T88) tells coders to “use secondary code(s) from Chapter 20, External Causes of Morbidity, to indicate cause of injury.”

Codes within the T section that include the external cause do not require an additional external cause code. S codes describe various types of injuries related to a single body region, and T codes describe injuries associated with unspecified body regions as well as poisonings and certain other consequences of external causes. Although CDI Specialists have not typically queried for external cause codes (E codes in ICD-9-CM and V00-Y99 codes in ICD-10-CM) these combination codes will require additional documentation from the provider detailing the events surrounding the injury once the new code set implementation takes place.

Regarding the circumstances of the injury, when no intent is indicated, the default is accidental, according to the Official Guidelines for Coding and Reporting. Although the available codes include “events of undetermined intent,” they should be used only if the physician specifically documents that the intent cannot be determined.

In ICD-10-CM injuries are grouped by body part rather than by category. The organization aligns with how providers document injuries–often a systematic progression from head to toe after the most serious injury is assessed. The focus of treatment can be misleading to those without a clinical background or expertise coding traumatic injuries.

For example, a patient may be int he ICU for a neurological injury that requires a high level of nursing care and repeat imaging but if the coder does not review the nursing and imaging report, all he or she may notice is that an open fracture of the limb was treated with required antibiotics and surgical care.

Although the grouping changed from ICD-9 to ICD-10, the Official Guidelines for Coding and Reporting are similar, calling for separate codes for each injury unless a combination code is required. Remember that a code can only ever be reported once, so duplicate codes should never appear on a claim. Also, use of a combination code may require a query if the documentation does not already support use of a particular combination code. The Figure below illustrates some of the changes in the injury code set.

Code Changes for Injuries

Editor’s Note: This excerpt was taken from The Clinical Documentation Improvement Specialist’s Guide to ICD-10, Second Edition, written by HCPro Boot Camp instructors Jennifer Avery and Cheryl Ericson.

12 Days of Mishaps Ready for ICD-10 Coding

Looking for your holiday wishes to come true? The present of CDI education is waiting to be unwrapped during December's collection of local networking meetings.

Looking for your holiday wishes to come true?

Our good friend, Michelle A. Leppert, over at the ICD-10 Trainer Blog took great pains (pun intended) this holiday season to chart out a selection of misadventures related to the traditional holiday theme song “The 12 Days of Christmas.”

On the first day of Christmas the house cat attacks the partridge in a pear tree which causes the bird to start hurling pears at the residents hitting our “true love” in the head.

On the second day, those turtle doves decided to spit seeds in his eyes and on the third day their two-year old decided to chase the three french hens, mimicking their flight and falling from the edge of the couch instead. On the fourth day, in an attempt to escape the fluttering onslaught of four calling birds our true love tripped on the coffee table and crashed through the sliding glass doors. Happily our hero decided to get golden rings for the fifth day. Unhappily little Andrew decided to see if one of them fit up his nose. It didn’t.

A host of other (hysterical as long as its fictional) mishaps ensue as the remaining seven days of holiday cheer come and go. We can’t imagine what the emergency room staff felt about all this. They must have called in the case management team for a little intervention at some point.

If you need any holiday-related excuses for a little ICD-10-CM/PCS coding review this collection of posts will help keep you chuckling while you do it.

Happy Holidays!

No more ICD-10 delay: Contact your local legislators today

ICD-10 implementation is not game. Tell your elected officials to stop playing around with the implementation date.

ICD-10 implementation is not game. Tell your elected officials to stop playing around with the implementation date.

Word has begun circulating throughout the healthcare industry that ICD-10 may face additional delay.

A letter drafted by Republican Michigan Representative Fred Upton and Republican Texas Representative Pete Sessions on behalf of the Medical Society of the State of New York seeks an additional two-year delay in the implementation of ICD-10 until October 1, 2017. You can read the letter here:

We at ACDIS strongly oppose further delay to ICD-10. Hospitals and CMS have already conceded with prior delays, at great cost: CMS estimated that the last delay cost the healthcare industry up to $6.8 billion in training, software, and other investments.

Further delay would result in additional costs, and also hurt patient care. The nation’s current coding and disease classification system, ICD-9, is out of date and desperately in need of the additional specificity that is the hallmark of ICD-10. Contrary to statements made in the above letter, improved coding specificity is not just tied to reimbursement, but also quality of care and patient safety.

It goes without saying that a further delay would also greatly damage the work already being done by CDI departments across the country, many of which have been diligently collaborating with their physician staffs with formal education and queries for the additional specificity needed under ICD-10.

ACDIS has received permission from our friends at the American Health Information Management Association (AHIMA) to share the following information with our members. It includes AHIMA’s recommended approach to contacting your local legislator and making your voice heard.

If you click this link, it will take you to Capwiz, a tool that makes it very easy to send letters directly to Congress: The form is pre-populated with reasons why the industry opposes efforts to delay ICD-10. This can be sent verbatim, or modified with your own thoughts and experiences with using ICD-10. The ACDIS advisory board stresses that you should urge Congress to act now, rather than wait to voice your opinion on the fate of ICD-10.

Congress is due to recess for the year on Friday, December 12. Time is of the essence, so please take action now.

If a delay is to occur, we all need to know in order to prepare and plan for 2015.

In addition, if you’d like to do more, consider the following course of action as recommended by AHIMA:

Call the leaders listed below TODAY and tell them that ICD-10 is needed in 2015.
Follow these 4 steps:

  1. Call Chairman Upton at 202-225-3761.
  2. Ask for the Health Legislative Aide
  3. Use the talking points below:
  • Do not delay ICD-10. We need the code sets in 2015!
  • According to a recent survey, small physician practices are expected to spend between $1,900—$6,000 to transition to the new code set. This is much lower than previous reports. The study can be found on
  • Physician practices do not use all 13,000 diagnosis codes available in ICD-9. Nor will it be required to use the 68,000 codes that are in ICD-10. The majority of the code increases are due to laterality-which is not currently available in ICD-9.
  • CMS offers a robust plan for physician practices to transition to ICD-10. The Road to 10 can be found here:

When you are done, call the other congressional leaders and Tweet also.

Name Phone                              Twitter Handle
Fred Upton 202-225-3761 @RepFredUpton
Pete Sessions 202-225-2231 @PeteSessions
House Speaker John Boehner 202-225-6205 @SpeakerBoehner
Minority Leader Nancy Pelosi 202-225-4965 @NancyPelosi
Kevin McCarthy 202-225-2915 @GOP Leader

Tweet your Representatives and be sure to use the following #s! #ICD10Matters #ICD10NoDelay

On behalf of ACDIS, thank you for making your voice heard on this important issue.


Brian Murphy

Director, ACDIS

Guest Post: Night before Christmas (um, ICD-10)

shawn.macphee (426x640)

Shawn Macphee

As part of its fall 2014 meeting the Michigan ACDIS Chapter held an essay contest. Although in the following hardly constitutes an essay (I do hold a master’s degree in poetry believe it or not and this falls into poetic realm), it nevertheless easily earned honors and was thankfully turned over to us here at ACDIS to share with you this holiday season. Kudos to the Michigan ACDIS Chapter leaders and to the poet, Shawn MacPhee, MSN, RN, CCDS!

‘Twas the night before ICD-10, when all through the house

Over the hills of ICD-10 preparation

Over the hills of ICD-10 preparation

not a CDS was sleeping, their anxiety wouldn’t douse

The code books were ready, studied with care

In hopes that the documentation would be there

The coders were nestled, all snug in their beds

While visions of procedure codes danced in their heads

The CFO was restless, the CEO too

Trying to trust the CDS knew just what to do

The next morning dawn came with a shatter

The CDS staff worked without much chatter

Census sheets printed off in a flash

They made assignments in a dash

To the floors they ran, with DRG books in tow

The freshly waxed floors all a glow

The physicians all a rounding did appear

With their handy new CDI tip cards near

Progress notes were written, H&P’s too

The CDS’s reviewed the charts, looking for a clue

Diagnoses like asthma, a-fib and gout

The CDS staff was on the look out

Specificity was on their mind

Acute or chronic their goal to find

Then what to their wondering eyes did appear?

The etiology and manifestations weren’t quite clear

A query must be done – it was true

So up to the physician the CDS flew

The physician agreed, and thanked the nurse

He appreciated her for being terse

The documentation was added

The chart was complete

The CDS decided it was time to repeat.

Reading health records throughout the day

Feeling proud to be leading the way

You see, ICD-10 it’s not scary

Once implemented we shall all be merry

The day is almost over – relaxation in sight

So query now, query often, and to all a good night!

News: CMS sets ICD-10 testing process in place

ICD-10 testing process in play

ICD-10 testing process in play

The new ICD-10 implementation date is less than a year away, and CMS is gearing up its end-to-end testing process in preparation.

CMS will select submissions from approximately 2,550 volunteers for three separate testing opportunities in January, April, and July 2015, and will make an effort to choose participants that represent a variety of provider, claim, and submitter types. MLN Matters SE1409 Revised states that the goal of the testing is to demonstrate the following:

  • Providers or submitters are able to successfully submit claims containing ICD-10 codes to the Medicare fee-for-service claims systems
  • CMS software changes made to support ICD-10 result in appropriately adjudicated claims (based on the pricing data used for testing purposes)
  • Accurate remittance advice is produced

Take action as early as possible regardless of whether your organization opts to test with CMS or another payer, says Barbara Hinkle-Azzara, RHIA, vice president of HIM operations at HRS Coding in Baltimore. Throughout the transition to ICD-10, organizations have made the mistake of assuming they will be able to test with payers only to find themselves left out because payers are only testing with a limited number of providers, she says.

Continue reading “ICD-10 countdown: Testing may offer a glimpse into the future” on the HCPro website.

TBT: Watch out for uninvited turkeys

Don't use Thanksgiving as a time to talk turkey. Count your blessings. Be thankful. Use compassion for those less fortunate who surround you.

Don’t use Thanksgiving as a time to talk turkey. Count your blessings. Be thankful.

Editor’s Note: In social media memes Throw-back Thursday generally means sharing an old high school photo, something you most likely wish had been left unpublished. We’ve picked up the theme going back into our archives to highlight some salient tid-bit. Today, in honor of Thanksgiving we’ve pillaged the archives over at the ICD-10 Trainer for this pearl pulled from the New York City headlines.

A feral flock of wild turkeys has invaded New York City. Seriously. And with them, they bring all sorts of code-ready diseases and mishaps. But what happens when a turkey tries to cross Broadway? Well, if the bird is unlucky, it will get run over. New Yorkers stop for no fowl.

However, if the birds are smart enough to cross en masse, they could cause some serious traffic disruptions and possibly some traffic accidents. We’ll leave the specific injuries (contusions, lacerations, broken bones, etc.) out of the equation for the moment and look at the External Causes codes associated with traffic accidents.

ICD-10-CM includes multiple code possibilities for transport accidents in sections V00-V99. The introductory note for the section states:

This section is structured in 12 groups. Those relating to land transport accidents (V01-V89) reflect the victim’s mode of transport and are subdivided to identify the victim’s ‘counterpart’ or the type of event. The vehicle of which the injured person is an occupant is identified in the first two characters since it is seen as the most important factor to identify for prevention purposes. 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.

If the turkeys on the Great White Way caused an accident, we would likely head to V40 (car occupant injured in collision with pedestrian or animal). Our choices include:

  • V40.0, car driver injured in collision with pedestrian or animal in nontraffic accident
  • V40.1, car passenger injured in collision with pedestrian or animal in nontraffic accident
  • V40.2, person on outside of car injured in collision with pedestrian or animal in nontraffic accident
  • V40.3, unspecified car occupant injured in collision with pedestrian or animal in nontraffic accident
  • V40.4, person boarding or alighting a car injured in collision with pedestrian or animal
  • V40.5, car driver injured in collision with pedestrian or animal in traffic accident
  • V40.6, car passenger injured in collision with pedestrian or animal in traffic accident
  • V40.7, person on outside of car injured in collision with pedestrian or animal in traffic accident
  • V40.9, unspecified car occupant injured in collision with pedestrian or animal in traffic accident

All of these codes require a seventh character to indicate the encounter type, so you’ll also need two placeholder Xs so the seventh character ends up in the seventh spot.

So if you’re flocking to New York for the holidays, watch out for those wild birds.