ICD_10_CM_101 - Injury_Surveillance_Methods_Toolkit (2023)

ICD_10_CM_101 - Injury_Surveillance_Methods_Toolkit (1)

This section is a quick reference to the basics of ICD-10-CM code types and structure. It includes a description of the two basic types of ICD-10-CM codes, a table illustrating diagnosis codes in ICD-10-CM that convey external cause (mechanism/intent) information, a description of the structure of ICD-10-CM codes, and two tables illustrating the key differences between ICD-9-CM and ICD-10-CM injury diagnosis codes and external cause of injury codes.

Types of ICD-10-CM codes

There are two basic types of ICD-10-CM codes used for injury and drug overdose surveillance:

  1. Diagnosis codes (“S” and “T” codes), which contain information about the body region and nature of injury – for example left leg fracture or scalp laceration
  2. External cause of injury codes (“V,” “W,” “X” and “Y” codes, and some T codes) which answer the following questions about the circumstances of the injury:
    • How did it occur? What was the mechanism or cause of the injury?
    • What was the intent? Unintentional, intentional self-harm, assault, or undetermined
    • Where did it occur? Place of occurrence codes (Y92)
    • What the person was doing at the time the injury occurred? Activity codes (Y93)
    • What was the person’s status at the time of injury? Status codes (Y99) Civilian, military, volunteer, or other

This toolkit focuses on ICD-10-CM diagnosis codes as well as external cause of injury codes that convey mechanism and intent information - referred to throughout this toolkit as “external cause of injury codes”. Place of occurrence, activity, and status external cause of injury codes may be useful to injury researchers and epidemiologists but are not explored in this toolkit.

Diagnosis codes and external cause of injury codes complement each other to give a rounded picture of an injury or overdose. External cause of injury codes are useful from a public health perspective because they shed some light on how and why an injury occurred and hence how it might have been prevented. On the contrary, diagnosis codes have more utility from a health service delivery perspective and inform reimbursement. Per the ICD-10-CM Official Guidelines for Coding and Reporting: “Unless a provider is subject to a state-based external cause of injury code reporting mandate or these codes are required by a particular payer, reporting of ICD-10-CM codes in Chapter 20, External Causes of Morbidity, is not required.” Thus, while medical coders are required to submit diagnosis codes for reimbursement purposes, the percentage of records that have both an injury diagnosis code and an external cause of injury code can vary by jurisdiction and facility. Epidemiologists should determine the rate of external cause coding within their dataset prior to interpreting the data.

It is important to note that in ICD-10-CM, a handful of “T” codes actually function as both a diagnosis and external cause of injury code. This applies to overdose codes (T36-T50) and toxic effects codes (T51-T65), where information about the drug or substance involved and the intent are captured a single code. There are several other “T” diagnosis codes that also contain external cause information. See table below.

Diagnosis codes in ICD-10-CM that convey external cause (mechanism/intent) information

ICD-10-CM Diagnosis code (T code)

Type of External Cause

T14.91

Suicide attempt

T15-T19

Effects of foreign body entering through natural orifice

T36-T50 with a 6th character of 1, 2, 3, or 4 (Exceptions: T36.9, T37.9, T39.9, T41.4, T42.7, T43.9, T45.9, T47.9, and T49.9 with a 5th character of 1, 2, 3, or 4)

Poisoning by drugs, medicaments, and biological substances

T51-T65

Toxic effects of substances chiefly non-medicinal as to source

T71

Asphyxiation

T73

Effects of deprivation

T74, T76

Adult and child abuse, neglect, and other maltreatment, confirmed or suspected

T75.0, T75.1, T75.2, T75.3

Effects of lightning, unspecified effects of drowning, effects of vibration, motion sickness

Structure of ICD-10-CM codes

Both diagnosis and external cause of injury codes in the ICD-10-CM code set can have three to seven alphanumeric characters. The first character is always alpha, the second character is always numeric, and characters 3-7 are alpha or numeric. The first three characters of an ICD-10-CM code designate the general category in which the code belongs, which is further expanded in the fourth, fifth, and sixth characters to add more specific details on related etiology (mechanism and/or intent), anatomic site, and severity. For codes related to injury and overdose, the 7th character denotes the encounter type (e.g., initial encounter, subsequent encounter, or sequelae). The character for encounter type must always be in the 7th position, so if a code has less than 6 characters and requires a 7th character extension, all of the empty character spaces should be filled with the placeholder “X”. A decimal is placed between the 3rd and 4th characters, however these decimals may be removed during the data cleaning and preparation stage.

Key Differences Between ICD-9-CM and ICD-10-CM3

Injury Diagnosis Codes

ICD-9-CM

ICD-10-CM

2,600 codes

43,000 codes

Code range 800-995

“S” and “T” codes

Codes consist of 3-5 characters

Codes consist of 3-7 characters; some codes have an “X” placeholder character to accommodate new codes in the future

Primary axis is nature of injury

Primary axis is body region

No character to indicate laterality

Characters within the code indicate left, right, bilateral, unspecified laterality

Limited detail on type of fracture

Detailed information on type of fracture

Laceration codes do not specify presence/absence of a foreign body

Laceration codes specify presence/absence of a foreign body

Limited information on superficial injuries

Detailed information on superficial injuries

Codes for poisoning and adverse effects of drugs

Codes for poisoning, adverse effects and underdosing of drugs

Poisoning: coded using both diagnosis codes and external cause of injury codes

Poisoning: coded using a diagnosis code only (T code); a character in the code identifies the intent of the poisoning (unintentional, intentional self-harm, assault, or undetermined)

Asphyxiation: 994.7

40 diagnosis codes for asphyxiation or strangulation by different mechanisms and intents

No distinction between suspected and confirmed child/adult abuse

New codes to distinguish between suspected and confirmed child/adult abuse

No distinction between initial and subsequent encounter for care

Most codes have a 7th character to distinguish between initial and subsequent encounter for care

Limited late effect codes

Most codes have a 7th character indicating sequelae (late effects)

External Cause of Injury Codes

ICD-9-CM

ICD-10-CM

1,300 codes

7,500 codes

External cause of injury codes begin with “E” and are commonly referred to as “E-codes”

External cause of injury codes begin with “V,” “W,” “X” or “Y”

Codes contains 3-5 characters

Code contains 3-7 characters; some codes have an “X” placeholder character to accommodate new codes in the future

No distinction between initial or subsequent encounters

7th character to designate initial or subsequent encounter

Limited external cause of injury codes for late effect

7th character indicates sequelae (late effects)

External cause of injury codes for intentional self-inflicted injuries are referred to as Suicide/self-inflicted

External cause of injury codes for intentional self-inflicted injuries are referred to as Intentional self-harm

External cause of injury codes for intentional harm by other persons are referred to as Homicide and injury purposely inflicted by other persons

External cause of injury codes for intentional harm by other persons are referred to as Assault

Includes specific external cause of injury codes for: poisoning and toxic effects of substances, asphyxiation, effects of foreign bodies, deprivation and neglect, lightning, and vibration.

Includes specific diagnosis (nature of injury) codes for: poisoning and toxic effects of substances, asphyxiation, effects of foreign bodies, deprivation and neglect, lightning, and vibration.

Includes external cause of injury codes for perpetrator of child and adult abuse (E967.0-.9); includes diagnosis codes for child maltreatment and abuse (995.50-995.59) and adult maltreatment and abuse (995.80-.85)

External cause of injury codes for perpetrator of assault, maltreatment and neglect (Y07) are expanded; includes diagnosis codes to specify adult and child abuse, neglect, and other maltreatment, confirmed (T74) and suspected (T76)


FAQs

How do you code an injury in ICD 10? ›

The ICD 10 coding scheme for reporting injury is as follows:
  1. First three characters: General category.
  2. Fourth character: The type of injury.
  3. Fifth character: Which body part was injured.
  4. Sixth character: Which hand was injured.
  5. Seventh character: The type of encounter (A, D, or S)
24 May 2018

What is the t icd 10? ›

It is important to note that in ICD-10-CM, a handful of “T” codes actually function as both a diagnosis and external cause of injury code. This applies to overdose codes (T36-T50) and toxic effects codes (T51-T65), where information about the drug or substance involved and the intent are captured a single code.

What are the 4 classifications of injuries? ›

The main types are primary, secondary, direct, indirect and chronic injury.

What is the difference between ICD-10 and icd11? ›

Changes from ICD-10 to ICD-11 include the introduction of new diagnoses, the refinement of diagnostic criteria of existing diagnoses, and notable steps in the direction of dimensionality for some diagnoses. However, there was no paradigm shift from ICD-10 to ICD-11 .

What is a component of ICD-10-CM? ›

The two parts of the ICD-10-CM index are the index to diseases and injury and index to external causes of injury. The table of drugs and chemicals and the neoplasm table are housed in the index to diseases and injury.

Where can I find a list of ICD-10 codes? ›

ICD-10 CM Guidelines, may be found at the following website: https://www.cdc.gov/nchs/icd/Comprehensive-Listing-of-ICD-10-CM-Files.htm.

What does an ICD-10 code look like? ›

ICD-10-CM is a seven-character, alphanumeric code. Each code begins with a letter, and that letter is followed by two numbers. The first three characters of ICD-10-CM are the “category.” The category describes the general type of the injury or disease. The category is followed by a decimal point and the subcategory.

What are 5 basic injury types? ›

Five Types of Injuries and Five Causes
  • Soft Tissue Injuries. Soft tissue injuries are some of the most common types of injuries. ...
  • Broken Bones. Our bones support our bodies and help us move. ...
  • Traumatic Brain Injuries. ...
  • Spinal Cord Injuries. ...
  • Psychological Injuries.
29 Oct 2019

What are the 7 types of injuries? ›

Summary
  • Animal bites.
  • Bruises.
  • Burns.
  • Dislocations.
  • Electrical injuries.
  • Fractures (broken bones)
  • Sprains and strains.
23 Jul 2014

What are the 7 common injuries? ›

8 Most Common Sports Injuries
  • Strains. Strains are by far the most common of all sports-related injuries simply because we use so many muscles and tendons when we exercise or play. ...
  • Sprains. ...
  • Knee injuries. ...
  • Fractures. ...
  • Tennis elbow. ...
  • Plantar fasciitis/shin splints. ...
  • Back injuries/back pain. ...
  • Concussion.

Is ICD-10 still used? ›

The ICD-10 codes we use today are more specific than ICD-9-CM codes and allow for detailed classifications of patients' conditions, injuries, and diseases. Medical coders are now equipped to capture anatomic sites, etiologies, comorbidities and complications, as well as severity of illnesses.

What is the purpose of ICD-11? ›

ICD-11 was specifically designed for the following use cases: Certification and reporting of causes of death. Morbidity coding and reporting including primary care.

Is ICD-11 used now? ›

The ICD-11 officially came into effect on 1 January 2022.

What are 3 purposes of ICD-10-CM? ›

ICD-10-CM/PCS code sets will enhance the quality of data for: Tracking public health conditions (complications, anatomical location) Improved data for epidemiological research (severity of illness, co-morbidities) Measuring outcomes and care provided to patients.

What is ICD-10-CM coding used for? ›

The ICD-10-CM is a morbidity classification published by the United States for classifying diagnoses and reason for visits in all health care settings. The ICD-10-CM is based on the ICD-10, the statistical classification of disease published by the World Health Organization (WHO).

What is ICD-10-CM and how is it used? ›

The ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) is a system used by physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care in the United States.

Where can I download ICD-10 codes? ›

The 2023 ICD-10-CM/PCS code sets are now fully loaded on ICD10Data.com. 2023/2022 codes became effective on October 1, 2022, therefore all claims with a date of service on or after this date should use 2023/2022 codes.

What is the easiest way to find ICD-10 codes? ›

A Five-Step Process
  1. Step 1: Search the Alphabetical Index for a diagnostic term. ...
  2. Step 2: Check the Tabular List. ...
  3. Step 3: Read the code's instructions. ...
  4. Step 4: If it is an injury or trauma, add a seventh character. ...
  5. Step 5: If glaucoma, you may need to add a seventh character.

What are the new 2022 ICD-10 codes? ›

Displaying codes 1-100 of 205:
  • A79. 82 Anaplasmosis [A. ...
  • C56. 3 Malignant neoplasm of bilateral ovaries.
  • C79. 63 Secondary malignant neoplasm of bilateral ovaries.
  • C84. 7A Anaplastic large cell lymphoma, ALK-negative, breast.
  • D55. 2 Anemia due to disorders of glycolytic enzymes.
  • D55. ...
  • D55. ...
  • D75.

What is the difference between a CPT code and an ICD-10 code? ›

While CPT codes are similar to ICD-10 codes, CPT codes identify services rendered, whereas ICD-10 codes represent patient diagnoses.

What are the 4 types of medical coding systems? ›

Right now, there are five major types of medical coding classification systems that are used by medical coding professionals — ICD-11, ICD-10-CM, ICD-10-PCS, CPT and HCPCS Level II. If you're interested in becoming a medical billing and coding professional, it's important to learn more about each system.

How is ICD-10 used to diagnose? ›

ICD-10 is used to translate diagnoses of diseases and other health problems from words (as described by a clinician) into an alphanumeric code which permits easy storage, retrieval and analysis of that data.

What should you do when coding injuries? ›

For aftercare of an injury, coders should assign the acute injury code with the appropriate seventh character "D" (or expanded choices for fractures) for subsequent encounter. This change will be significant for those post-acute settings that provide subsequent care for injuries.

When sequencing codes for injuries which code should go first? ›

Coding conventions require the condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a “code first” note with the manifestation code and a “use additional code” note with the etiology code in ICD-10.

Which code is sequenced first when coding injuries? ›

Sequence first the code that reflects the highest degree of burn when more than one burn is present . When the reason for the admission or encounter is for the treatment of external multiple burns, sequence first the code that reflects the burn of the highest degree.

What are injury codes? ›

What are injury diagnosis codes? The injury diagnosis codes (or nature of injury codes) are the ICD codes used to classify injuries by body region (for example, head, leg, chest) and nature of injury (for example, fracture, laceration, solid organ injury, poisoning).

What are the 7 steps a coder should follow? ›

The process is easier when you break it into seven steps:
  • Review the header of the report.
  • Review the CPT® codebook (start in the Index).
  • Review the report/documentation.
  • Make a preliminary code selection.
  • Review the guidelines (for the preliminary codes).
  • Review policies and eliminate the extras.
1 Apr 2017

What are the 4 steps of coding? ›

Here's how we can do so in four major steps.
...
Computer Programming in 4 Steps
  • Step 1: Identify the problem. ...
  • Step 2: Find a solution. ...
  • Step 3: Code it. ...
  • Step 4: Test it.
13 Jul 2022

What is the last step in finding an ICD-10-CM code? ›

The final step in locating a code is a review of the chapter-specific coding guidelines found before the alphabetic index of the ICD-10 manual. This index includes guidelines for specific diagnoses or conditions. Some of the more complex diagnosis codes can be found here including HIV and sepsis.

Which ICD-10-CM must be listed first on a claim? ›

"List first the ICD-10-CM code for the diagnosis, condition, problem, or other reason for encounter/visit shown in the medical record to be chiefly responsible for the services provided. List additional codes that describe any coexisting conditions.

What are the 5 steps to correct code? ›

A Five-Step Process
  1. Step 1: Search the Alphabetical Index for a diagnostic term. ...
  2. Step 2: Check the Tabular List. ...
  3. Step 3: Read the code's instructions. ...
  4. Step 4: If it is an injury or trauma, add a seventh character. ...
  5. Step 5: If glaucoma, you may need to add a seventh character.

What is true about ICD-10-CM codes? ›

ICD-10-CM codes are alphanumeric, with all codes beginning with a number. ICD-10-CM codes have a maximum of five characters. The letter N is assigned as a fifth character placeholder for certain six-character codes. The ICD-10-CM, the WHO version, does not include a procedure classification (Volume 3).

What are the six steps in the coding process? ›

6 Key Steps in the Medical Coding Process
  1. Action 1. Abstract the documentation. ...
  2. Action 2. Query, if necessary. ...
  3. Action 3. Code the diagnosis or diagnoses.
  4. Action 4. Code the procedure or procedures. ...
  5. Action 5. Confirm medical necessity. ...
  6. Action 6. Double-check your codes.
4 Dec 2019

What are the 3 classifications of injury? ›

Did you know that most athletic injuries can be boiled down into three main categories? Acute, Overuse, and Chronic.

What is the ICD-10 code for injury at work? ›

ICD-10-CM Code for Encounter for examination and observation following work accident Z04. 2.

What is the ICD-10 code for traumatic injury? ›

ICD-10-CM T14. 90XA is grouped within Diagnostic Related Group(s) (MS-DRG v40.0): 913 Traumatic injury with mcc. 914 Traumatic injury without mcc.

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