ICD 10 CM Chapter Specific Guidelines I. C19

Dr. Lisa L Campbell®

13 Feb 201932:55

EducationalLearning

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TLDRIn this informative session, Dr. Kambou delves into ICD-10-CM coding guidelines, focusing on Chapter 19 which covers injury, poisoning, and certain consequences of external causes. The discussion highlights the importance of the seventh character requirement for most codes, the distinction between initial encounters, subsequent encounters, and sequelae, and the proper sequencing of injuries and fractures. The session also addresses the coding of burns and corrosives, poisoning, underdosing, toxic effects, and complications of care, providing essential insights for accurate medical coding practices.

Takeaways

📚 ICD-10-CM Chapter 19 focuses on injury, poisoning, and certain other consequences of external causes, with code range S0-0 through T88.
🌟 Most codes in Chapter 19 require a seventh character, with exceptions like fractures, and have three options: initial encounter (A), subsequent encounter (D), and sequela (S).
🩺 The seventh character 'A' for initial encounter is used for active treatment of the condition, regardless of the provider seeing the patient.
🛌 For subsequent encounters, the 'D' character is used after active treatment is completed and during the healing or recovery phase.
🌀 The 'S' character for sequela is used for complications or conditions arising directly from the initial injury or event.
🤕 When coding injuries, assign separate codes for each injury unless a combination code is provided; do not use aftercare Z codes for injuries with available seventh characters.
🦴 Traumatic fractures are coded with individual site codes and the appropriate seventh character for the initial encounter, with specific rules for multiple and open fractures.
🔥 Burns and corrosives are coded based on the degree, extent, and agent of the injury, with separate codes for current burns and sequela.
💊 Adverse effects of drugs are coded with the nature of the adverse effect first, followed by the specific drug code; poisonings are coded in reverse order.
🚨 In cases of abuse, neglect, or maltreatment, use T74 for confirmed cases and T76 for suspected cases, with additional codes to identify the cause and any mental health or injury codes.
🏥 Complications of care are coded based on the medical device or transplant involved, with specific codes for transplant complications and intraoperative/post-procedural issues.

Q & A

What is the focus of Chapter 19 in ICD-10-CM coding guidelines?
-Chapter 19 focuses on injury, poisoning, and certain other consequences of external causes, with code family S0 0 through T88.
What does the seventh character 'A' in ICD-10-CM codes signify?
-The seventh character 'A' signifies an initial encounter where the patient is receiving active treatment for the condition.
How is the seventh character 'D' used in ICD-10-CM codes?
-The seventh character 'D' is used for subsequent encounters after the patient has completed active treatment and is receiving routine care during the healing or recovery phase.
What is the difference between 'aftercare Z codes' and the seventh character 'S' in ICD-10-CM codes?
-Aftercare Z codes are used for routine care following a surgical procedure, while the seventh character 'S' is used for complications or conditions that arise as a direct result of the condition, such as a scar from a burn.
When should combination codes be used in ICD-10-CM injury coding?
-Combination codes should be used when they are provided for multiple injuries or conditions, instead of assigning separate codes for each injury.
How are multiple traumatic fractures coded in ICD-10-CM?
-Multiple traumatic fractures should be coded individually by site, in accordance with the provisions within a particular category and the level of detail available in the medical record.
What is the correct sequencing for multiple burns in ICD-10-CM?
-The code reflecting the highest degree of burn should be sequenced first when there is more than one burn present.
How are adverse effects of drugs coded in ICD-10-CM?
-Adverse effects of drugs are coded by first sequencing the appropriate code for the nature of the adverse effect, followed by the code for the specific drug causing the adverse effect.
What is the significance of the 'rule of nines' in burn coding?
-The rule of nines is a classic method used to estimate the extent of body surface involved in a burn and is used to classify burns according to the extent of body surface involvement.
How are complications of care coded in ICD-10-CM?
-Complications of care are coded by first identifying the appropriate code from the T code section, and then adding additional codes if necessary to describe the specific complication.
What should be done when a suspected case of abuse, neglect, or mistreatment is ruled out?
-When a suspected case is ruled out, codes from category Z00.7 are used for adults and children to indicate the encounter for observation following the ruling out of abuse or neglect.

Outlines

00:00

📚 Introduction to ICD-10-CM Chapter 19: Injury, Poisoning, and External Causes

This paragraph introduces the focus of the session, which is on ICD-10-CM Chapter 19, covering injury, poisoning, and certain other consequences of external causes (code family S00-T88). It emphasizes the importance of the seventh character requirement for most codes in this chapter, with exceptions for fractures. The three options for the seventh character are explained: initial encounter (A), subsequent encounter (S), and sequela (T). The paragraph also discusses the use of the seventh character for initial encounters, which is used for active treatment, regardless of whether it's the first time the provider is seeing the patient. It highlights the distinction between active treatment and aftercare, especially for infections related to prosthetic devices.

05:04

🩺 Coding Injuries and Traumatic Fractures

This paragraph delves into the specifics of coding injuries and traumatic fractures. It clarifies that combination codes should be used if provided, and separate codes for each injury unless specified otherwise. The paragraph also discusses the rules for sequencing injuries based on severity and the use of specific ICD-10-CM codes for different types of injuries, such as superficial injuries and primary injuries involving nerves and blood vessels. Additionally, it addresses the coding of fractures, including multiple coding for fractures, the use of the seventh character for initial and subsequent encounters, and the distinction between open and closed fractures.

10:08

🔥 Coding Burns and Corrosives

This section focuses on the coding of burns and corrosives, highlighting the ICD-10-CM's distinction between burns and corrosions. It explains the classification of burns by degree, extent, and agent, and the sequencing rules for multiple burns. The paragraph also covers the coding of burns from multiple sites, the use of additional codes for evaluating burn mortality, and the treatment of sequela of burns or corrosions. It advises against using vague codes and emphasizes the importance of using specific codes for each burn site and the appropriate seventh character for sequela.

15:10

💊 Adverse Effects, Poisoning, Underdosing, and Toxic Effects

This paragraph discusses the coding of adverse effects, poisoning, underdosing, and toxic effects. It outlines the use of specific ICD-10-CM codes for these conditions and the importance of consulting the tabular list rather than the alphabetical index for drug and chemical codes. The paragraph explains the sequencing rules for adverse effects and poisonings, the use of codes for underdosing, and the classification of toxic effects. It also addresses the need to use the appropriate codes to describe all drugs involved and the unique ICD-10-CM code reporting rule for encounters.

20:10

🚨 Adult and Child Abuse, Neglect, and Maltreatment

This section addresses the coding of adult and child abuse, neglect, and other maltreatment. It explains the use of codes T74 and T76 for confirmed and suspected cases, respectively, and the addition of external cause codes for physical injuries resulting from abuse. The paragraph also discusses the coding of suspected cases that are ruled out, using specific Z codes for adults and children. It highlights the importance of careful code selection, especially when other codes may apply, and the distinction between suspected and confirmed cases in terms of external cause and perpetrator codes.

25:12

🩺 Complications of Care and Transplant Issues

This paragraph covers the coding of complications of care, including pain due to medical devices and transplant complications. It specifies the use of codes in Chapter 19 for pain due to medical devices and additional codes in other chapters for transplant complications. The paragraph explains the conditions under which a transplant complication code is assigned and the distinction between complications that affect the function of the transplanted organ and those that do not. It also touches on the coding of intraoperative and post-procedural complications, which are found at the end of the body system chapters and should be sequenced first, followed by a secondary code for the specific complication.

30:12

📋 Summary of ICD-10-CM Chapter 19 and Transition to Chapter 20

This final paragraph summarizes the key points discussed in Chapter 19 and provides a transition to the next session, which will cover external causes of morbidity (Chapter 20). It reiterates the importance of understanding the coding guidelines for injuries, poisonings, and external causes, and encourages the audience to continue learning and applying these guidelines in their coding practices.

Mindmap

Keywords

💡ICD-10-CM Coding

ICD-10-CM Coding refers to the process of classifying medical diagnoses and procedures using codes from the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). This is essential for medical billing, record-keeping, and statistical analysis. In the video, the speaker is conducting a session to educate about specific coding guidelines, particularly focusing on Chapter 19 which deals with injuries, poisonings, and certain other consequences of external causes.

💡Seventh Character Requirement

The seventh character requirement in ICD-10-CM coding is an additional digit that provides further specification for certain codes, particularly those in Chapter 19. This character can indicate whether the patient is in the initial stage of treatment (A), a subsequent stage (D), or is experiencing sequelae (S). The correct use of the seventh character is crucial for accurate medical documentation and reimbursement.

💡Initial Encounter

An initial encounter in medical coding refers to the first contact a patient has with a healthcare provider for a specific condition, where active treatment is being administered. The seventh character 'A' is used to indicate this stage in ICD-10-CM coding, which is important for understanding the timing and nature of the patient's treatment.

💡Subsequent Encounter

A subsequent encounter in medical coding describes any patient visit after the initial treatment phase for a condition, typically during the healing or recovery period. The seventh character 'D' is used in ICD-10-CM codes to denote these follow-up visits, which are crucial for tracking the ongoing care and management of a patient's health condition.

💡Sequela

Sequela refers to a condition that is a direct consequence or aftereffect of a disease, injury, or other medical condition. In ICD-10-CM coding, the seventh character 'S' is used to indicate that a patient is being treated for a sequela. This is significant for capturing the long-term impacts of a condition and for understanding the continuity of care.

💡Traumatic Fractures

Traumatic fractures are breaks in bones that result from external forces or injuries. In the context of ICD-10-CM coding, these fractures have specific codes and rules for classification, including the use of seventh characters to indicate the stage of treatment. Understanding how to code traumatic fractures correctly is important for accurate documentation and treatment planning.

💡Burns and Corrosives

Burns and corrosives refer to injuries caused by heat, chemicals, electricity, or radiation. In ICD-10-CM coding, these types of injuries are classified based on their severity, extent, and agent causing the injury. Accurate coding of burns and corrosives is essential for tracking treatment and recovery, as well as for research and statistical analysis.

💡Adverse Effects

Adverse effects are unintended negative reactions that occur when a medication is taken as prescribed. In medical coding, these effects are captured using specific ICD-10-CM codes that reflect the nature of the adverse effect and the medication involved. This is important for monitoring medication safety and for identifying patterns of adverse drug reactions.

💡Poisoning

Poisoning refers to the harmful effects on the body caused by the ingestion, inhalation, or skin contact with a toxic substance. In ICD-10-CM coding, poisoning is classified based on the substance involved and the intent (accidental, intentional self-harm, assault, etc.). Correct coding of poisoning is crucial for understanding the epidemiology of poisoning cases and for prevention efforts.

💡Complications of Care

Complications of care are adverse outcomes that arise from medical procedures or treatments. These can include infections, pain due to medical devices, or transplant rejections. In ICD-10-CM coding, complications of care are identified with specific codes that reflect the nature of the complication and the related procedure, which is vital for quality improvement and patient safety analysis.

💡External Cause Codes

External cause codes in ICD-10-CM are used to identify the external factors that contribute to an injury or illness, such as the cause of a burn or the intent behind a poisoning. These codes are essential for understanding the circumstances surrounding an injury or poisoning and for public health surveillance and prevention efforts.

Highlights

Focus on Chapter 19 of ICD-10-CM coding guidelines, which deals with injury, poisoning, and certain other consequences of external causes (code family S00-T88).

Most codes in Chapter 19 require a seventh character, with exceptions like fractures, and the three options for the seventh character are initial encounter (A), subsequent encounter (D), and sequela (S).

Initial encounter (A) is used for active treatment of the condition, regardless of whether it's the first time the provider is seeing the patient.

Subsequent encounter (D) is used after the patient has completed active treatment and is in the healing or recovery phase.

Sequela (S) is used for complications or conditions that arise as a direct result of the initial injury, and both the injury code and the sequela code should be used.

When coding injuries, assign separate codes for each injury unless a combination code is provided; do not use the category T07 for unspecified multiple injuries in an inpatient setting.

For traumatic fractures, use the appropriate 7th character for the initial encounter (active treatment) and subsequent care (healing or recovery phase).

Non-union and malunion fractures have specific 7th character subsequent care codes, distinct from the general A, D, or S.

Open fractures are classified using the Gustilo-Anderson (GU still o) system, with specific 7th character values for type 1 or type 2 open fractures.

Adverse effects of drugs should be sequenced with the nature of the adverse effect first, followed by the drug code; for poisonings, the sequence is reversed.

Underdosing refers to taking less medication than prescribed or stopping use on one's own initiative, and should not be used as a principal or first-listed code.

Toxic effects are classified in categories T51-T65, with an associated intent (accidental, intentional self-harm, assault, undetermined) based on medical record documentation.

For abuse, neglect, and maltreatment, use T74 for confirmed cases and T76 for suspected cases; external cause codes should be added for physical injuries in confirmed cases.

In cases where abuse, neglect, or mistreatment is suspected but ruled out, use Z04.71 for adults and Z04.72 for children; do not use T76 in these situations.

Complications of care are coded based on whether they affect the function of a medical device or transplanted organ, with specific codes in Chapter 19 and additional codes in other chapters.

Intraoperative and post-procedural complications are coded with specific codes found at the end of each body system chapter, sequenced first followed by a secondary code for the specific complication.

Burns and corrosives are coded differently in ICD-10-CM, with burns being thermal injuries and corrosives being chemical-induced; both have the same coding guidelines.

For burns, assign separate codes for each burn site and use additional codes to indicate the extent of body surface involvement and the rule of nines classification.

Sequela of burns or corrosion is coded with a 7th character of S, and when a current burn and sequela of an old burn coexist, both codes may be assigned on the same record.

External cause codes should be used with burns and corrosion to identify the source, intent, and place of occurrence of the burn or corrosive substance.

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