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ICD-10-CM & ICD-10-PCS CODING
ROUNDTABLES
Emergency Room Scenarios

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ICD-10-CM: Diagnosis Coding

Chapter 19
Injury, poisoning and certain other consequences of external causes
Includes codes beginning with S00 through codes beginning with T88
Examples of codes in Chapter 19 include:
Fractures
Nerve, blood vessel, superficial, muscle, or tendon injuries
Open wounds

Chapter 19 Guidelines
Most categories in chapter 19 have a 7th character requirement for each applicable code. This requirement will describe the type of encounter. A: Initial Encounter
Used while the patient is receiving active treatment for the condition.
Examples of active treatment: surgical treatment, emergency department encounter, and evaluation & treatment by a new physician.
D: Subsequent Encounter S: Sequela
**Categories for traumatic fractures have a separate set of 7th character values.

Injuries
When coding injuries, assign separate codes for each injury unless a combination code is provided, in which case the combination code is assigned. Traumatic injury codes (S00-T14.9) are
not to be used for normal, healing surgical wounds or to identify complications of surgical wounds.
The code for the most serious injury, as determined by the provider and the focus of treatment, is sequenced first.

Superficial Injuries
Superficial injuries such as abrasions or contusions are not coded when associated with more severe injuries of the same site.

Nerves & Blood Vessels
When a primary injury results in minor damage to peripheral nerves or blood vessels, the primary injury is sequenced first with additional code(s) for injuries to nerves and spinal cord (such as category S04), and/or injury to blood vessels (such as category S15).
When the primary injury is to the blood vessels or nerves, that injury should be sequenced first.

Traumatic Fractures
Displaced and nondisplaced are new terms that have been added in ICD-10.
A fracture not indicated whether displaced or not displaced should be coded to displaced.
A fracture not indicated as open or closed should be coded to closed.
Be on the lookout for new classifications and types of fractures in ICD-10 codes:
Gustilo Classification
Salter-Harris Type
Bartons, Colles, Smith, etc.

Fracture: Encounter Type
Initial Encounter for Fracture (Receiving active treatment) Examples of active treatment: surgical treatment,
emergency department encounter, and evaluation and treatment by a new physician.
The appropriate 7th character for initial encounter should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion.
Subsequent Encounter for Fracture (Routine care during recovery)
With Routine Healing
With Delayed Healing
With Nonunion
With Malunion
Sequela (Indicates a late effect of the fracture)

Multiple Fractures
Multiple fractures are sequenced in accordance with the severity of the fracture.

LETS PRACTICE Diagnosis Coding!

Scenario #1 SEE PRINTOUT AND
ASSIGN CODES!

Coding Scenario #1 Answers
S42.032A - Displaced fracture of lateral end of left clavicle, initial encounter for closed fracture
W19.XXXA - Unspecified fall, initial encounter
Z86.73 - Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits
Z95.0 - Presence of cardiac pacemaker
I10 - Essential (primary) hypertension

ASSIGN CODES!

S43.085A Other dislocation of left shoulder joint, initial encounter
W19.XXXA - Unspecified fall, initial encounter
Y92.129 - Unspecified place in nursing home as the place of occurrence of the external cause
E78.5 Hyperlipidemia, unspecified
Z86.73 - Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits

ASSIGN CODES!

F07.81 - Postconcussional syndrome
E03.9 - Hypothyroidism, unspecified
E11.9 - Type 2 diabetes mellitus without complications

ASSIGN CODES!

S82.831A - Other fracture of upper and lower end of right fibula, initial encounter for closed fracture
W07.XXXA - Fall from chair, initial encounter
K21.9 - Gastro-esophageal reflux disease without esophagitis
M81.0 - Age-related osteoporosis without current pathological fracture
E78.0 - Pure hypercholesterolemia

ASSIGN CODES!

S10.83XA - Contusion of other specified part of neck, initial encounter
S20.229A - Contusion of unspecified back wall of thorax, initial encounter
W20.8XXA - Other cause of strike by thrown, projected or falling object, initial encounter

ASSIGN CODES!

S92.211A - Displaced fracture of cuboid bone of right foot, initial encounter for closed fracture
S92.001A - Unspecified fracture of right calcaneus, initial encounter for closed fracture
S92.251A - Displaced fracture of navicular [scaphoid] of right foot, initial encounter for closed fracture
J45.909 - Unspecified asthma, uncomplicated
F17.210 - Nicotine dependence, cigarettes, uncomplicated
W10.9XXA - Fall (on) (from) unspecified stairs and steps, initial encounter
Y92.814 - Boat as the place of occurrence of the external cause

ASSIGN CODES!

S62.501A - Fracture of unspecified phalanx of right thumb, initial encounter for closed fracture
W22.8XXA - Striking against or struck by other objects, initial encounter
Y93.64 - Activity, baseball

ASSIGN CODES!

S71.112A - Laceration without foreign body, left thigh, initial encounter
W27.8XXA - Contact with other nonpowered hand tool, initial encounter

ICD-10-CM: Question and
Answer Session

ICD-10-PCS: Procedure Coding

Procedure Sections
Medical and Surgical Drainage, Repair
Placement Packing, Immobilization, Compression,
Dressing
Administration Transfusion, Irrigation
Extracorporeal Assistance and Performance Restoration

Medical and Surgical Section
Includes 31 root operations
Be sure to keep the definitions of these root operations handy. Look for them at the front of your ICD-10-PCS codebook.
Procedure codes from this section will always have a first character of
0

Drainage
Taking or letting out fluids and/or gases from a body part.
Example: Percutaneous chest tube placement for right pneumothorax
0W9930Z

Repair
Restoring, to the extent possible, a body part to its normal anatomic structure and function.
Example: Bilateral Inguinal Open Herniorrhaphy
0YQA0ZZ
Remember that if MESH is used during a hernia repair it will be considered a different root operation

Placement Section
Includes 7 root operations.
The root operations represent procedures for putting a device in or on a body region for the purpose of protection, immobilization, stretching, compression, or packing.
2

Placement Section
Packing
Putting material in a body region or orifice.
Example: Packing of abdominal wall wound
2W43X5Z

Placement Section
Immobilization
Limiting or preventing motion of an external body region
Example: Application of cast to right wrist
2W3CX2Z

Placement Section
Compression
Putting pressure on a body region
Example: Placement of intermittent pneumatic compression device, covering right lower leg
2W1LX7Z

Placement Section
Dressing
Putting material on a body region for protection
Example: Sterile dressing placement to wound of the chest wall
2W24X4Z

Administration Section
Includes 3 root operations.
The root operations represent procedures for putting in or on a therapeutic, prophylactic, protective, diagnostic, nutritional, or physiological substance.
3

Transfusion
Putting in blood or blood products
Example: Bone marrow transplant using donor marrow from identical twin, central vein infusion
30243G1

Irrigation
Pu

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