1. Colorado Trauma Network/ Colorado Trauma Registry Health and Safety Data Services Coding Injuries in ICD10CM 10/1/2014

2. ICD9CM codeDescriptionICD10CM main code Description 820Fracture of neck of femurS72.0Fracture of head and neck of femur S72.1Pertrochanteric fracture S72.2Subtrochanteric fracture of femur S79.0Physeal fracture of upper end of femur Health and Safety Data Services Been injured in a spacecraft? Roughed up by an Orca whale? Know someone who drowned from jumping off burning water skis? Don’t worry! There’s a code for that!

3. ICD10CM Conventions Health and Safety Data Services ICD10CM code structure – Specific injury site (e.g., head, S00-S09; neck, S10-S19) are grouped rather than grouping by injury type as in ICD9CM (e.g., fractures, 800-829; dislocations, 830-839) – More details for specific body regions (e.g., right/left, bilateral, open/closed, rupture, severity of open fractures) – Codes with no predecessor in ICD9CM Under dosing Blood type Glasgow Coma Scale

4. ICD10CM Conventions Health and Safety Data Services One ICD9CM code can be represented by multiple ICD10CM codes ICD9CMDescriptionICD10CMDescription 807.03Closed fracture of three ribs S22.4 Multiple fractures of ribs S22.41 Multiple fractures of ribs, right side S22.42 Multiple fractures of ribs, left side S22.43 Multiple fractures of ribs, unilateral S22.49 Multiple fractures of ribs, unspecified side Red = General Equivalence Mappings (GEMS) GEMS are not a substitute for learning how to use ICD10CM!

5. ICD10CM Conventions Health and Safety Data Services Level of Detail in Coding Composed of codes with 3, 4, 5, 6 or 7 digits Three digits as the heading of a category Can be followed by fourth and/or five digits which provide greater detail Seventh position and placeholders “X” is used as a placeholder at certain codes to ensure the seventh value is always in the seventh position (also allows for future expansion) The seventh position is the episode of care (initial, subsequent, sequela) e.g., “A” (for initial encounter) is in the seventh position in “S03.4xxA Sprain of jaw, initial encounter”

6. ICD10CM Coding Manual Health and Safety Data Services The latest version of the ICD10CM coding manual is available at: http://www.cdc.gov/nchs/icd/icd10cm.htm – Scroll down to “FY 2015 release of ICD-10-CM” and click on “ICD-10-CM PDF Format” and then “ICD10CM_FY2015_Full_PDF.zip” file, and then the “FY15_Tabular” file and go to Chapter 19 This website posts a new coding manual each year, which includes any new codes that have been added The new version goes into effect on October 1 each year

7. ICD9CM codeDescriptionICD10CM main code Description 820Fracture of neck of femurS72.0Fracture of head and neck of femur S72.1Pertrochanteric fracture S72.2Subtrochanteric fracture of femur S79.0Physeal fracture of upper end of femur Health and Safety Data Services Exclusion: exclude tortoises – there’s a different code for that! Don’t worry! There’s a code for that!

8. ICD9CM codeDescriptionICD10CM main code Description 820Fracture of neck of femurS72.0Fracture of head and neck of femur S72.1Pertrochanteric fracture S72.2Subtrochanteric fracture of femur S79.0Physeal fracture of upper end of femur Health and Safety Data Services Chapter 19 – Injury Diagnosis Codes The basic structure in ICD10CM (3-7 positions) #1-Chapter (alpha –all letters except U) #2 -Major body region (always numeric) #3 -Major nature of injury #4-6 -specific body region and nature of injury (placeholder when necessary) #7 - type of encounter A = Initial, D = Subsequent S = Sequela (with the exception of fractures) #1 Injury chapter #2 Elbow and forearm #3 Fracture. Decimal #4 upper end of radius #5 neck of radius #6 displaced, right radius #7 Initial encounter S52.131A Displaced fracture of neck of right radius, initial encounter for closed fracture

9. ICD9CM codeDescriptionICD10CM main code Description 820Fracture of neck of femurS72.0Fracture of head and neck of femur S72.1Pertrochanteric fracture S72.2Subtrochanteric fracture of femur S79.0Physeal fracture of upper end of femur Health and Safety Data Services Code Positions 1-2 1: chapter 2: major body region 2: Major Body Region of Injury SiteICD10CM positions 1-2 headS0 neckS1 thoraxS2 abdomen, lower back, lumbar spine, pelvis and external genitalsS3 shoulder and upper armS4 elbow and forearmS5 wrist, hand and fingersS6 hip and thighS7 knee and lower legS8 ankle and footS9

10. ICD9CM codeDescriptionICD10CM main code Description 820Fracture of neck of femurS72.0Fracture of head and neck of femur S72.1Pertrochanteric fracture S72.2Subtrochanteric fracture of femur S79.0Physeal fracture of upper end of femur Health and Safety Data Services 3: Major nature of injury 2: Major body region SuperficialOpenFractureD/S/SD/S/SNerves Blood vessels Muscle and tendons CrushAmp.Other headS00S01S02S03S04 S05 eye/orbit S06 intracranial S07S08S09 neckS10S11S12S13S14S15S16S17xS19 thoraxS20S21S22S23S24S25heart S26S27S28S29 abdomen, lower back, lumbar spine and pelvis S30S31S32S33S34S35 S36 abd-organs S37S38S39 shoulder and upper armS40S41S42S43S44S45S46S47S48S49 elbow and forearmS50S51S52 S53 elbow S54 S55 forearm S56 forearm S57S58S59 wrist and handS60S61S62S63S64S65S66S67S68S69 hip and thighS70S71S72 S73 hip S74S75S76S77S78S79 knee and lower legS80S81S82 S83 knee S84 low-leg S85 low-leg S86 low-leg S87S88S89 ankle and footS90S91S92S93S94S95S96S97S98S99 *D/S/S = joint dislocation/sprain/strain Position 3 Major Nature of Injury Within each major body region, injuries are organized from superficial to deeper body structures

11. ICD9CM codeDescriptionICD10CM main code Description 820Fracture of neck of femurS72.0Fracture of head and neck of femur S72.1Pertrochanteric fracture S72.2Subtrochanteric fracture of femur S79.0Physeal fracture of upper end of femur Health and Safety Data Services Position 4 2: Major body region 3: Major nature of injury Common 4 th position terms SuperficialOpenFractureD/S/SD/S/S headS00Scalp, eyelid, nose, ear, lips and oral cavity neckS11 Larynx and trachea, thyroid, pharynx and cervical esophagus thoraxS22 Thoracic vertebra, sternum, one rib, multiple ribs, flail chest abdomen, lower back, lumbar spine, pelvis S33 Lumbar intervertebral disc, lumbar vertebra, sacroiliac and sacrococcygeal joint, unspecified parts of lumbar spine and pelvis, rupture of symphysis pubis, ligaments of lumbar spine 4: Often a specific body region (subsection of 2 (e.g., from head to nose)). Also see “other parts” or “unspecified” – similar to what would be derived from a ICD9CM GEM

12. ICD9CM codeDescriptionICD10CM main code Description 820Fracture of neck of femurS72.0Fracture of head and neck of femur S72.1Pertrochanteric fracture S72.2Subtrochanteric fracture of femur S79.0Physeal fracture of upper end of femur Health and Safety Data Services Fracture of Femoral Neck ICD9CM codeDescriptionICD10CM main codeDescription 820 Fracture of neck of femur S72.0Fracture of head and neck of femur S72.1Pertrochanteric fracture S72.2Subtrochanteric fracture of femur S79.0Physeal fracture of upper end of femur 1: chapter 2: major body region 3: major nature of injury 4: specific body region (often a subsection of 2; e.g., hip to femur)

13. ICD9CM codeDescriptionICD10CM main code Description 820Fracture of neck of femurS72.0Fracture of head and neck of femur S72.1Pertrochanteric fracture S72.2Subtrochanteric fracture of femur S79.0Physeal fracture of upper end of femur Health and Safety Data Services Fracture of Rib(s), Sternum, Larynx and Trachea ICD9CM codeDescriptionICD10CM main codeDescription 807 Fracture of rib(s), sternum, larynx and trachea S12.8Fracture of other parts of neck S22.2Fracture of sternum S22.3Fracture of one rib S22.4Fracture of multiple ribs S22.5Flail chest 1: chapter 2: major body region 3: major nature of injury 4: specific body region (e.g., from neck to trachea)

14. ICD9CM codeDescriptionICD10CM main code Description 820Fracture of neck of femurS72.0Fracture of head and neck of femur S72.1Pertrochanteric fracture S72.2Subtrochanteric fracture of femur S79.0Physeal fracture of upper end of femur Health and Safety Data Services Position 5 3: major nature of injury 4 th positionCommon 5 th position terms Superficial injury of head (S00) Superficial injury of ear (S00.4) abrasion, blister (nonthermal), contusion, external constriction, foreign body, insect bite (nonvenomous), other bite Open wound of neck (S11) Open wound of thyroid gland (S11.1) laceration or puncture w/ w/o foreign body, bite Fracture of rib(s), sternum and thoracic spine (S22) Multiple fracture of ribs (S22.4) Right/left side, bilateral Dislocation and sprain of joints and ligaments of lumbar spine and pelvis (S33) Subluxation and dislocation of lumbar vertebra (S33.1) L1/L2…L4/L5 lumbar vertebra 4: specific body region 5: often a specific nature of injury (often associated with 3; e.g., from open to puncture); sometimes a cause code (e.g., bite)

15. ICD9CM codeDescriptionICD10CM main code Description 820Fracture of neck of femurS72.0Fracture of head and neck of femur S72.1Pertrochanteric fracture S72.2Subtrochanteric fracture of femur S79.0Physeal fracture of upper end of femur Health and Safety Data Services 4 th position5 th position codeCommon 6 th position terms Superficial injury of ear (S00.4) External constriction of ear (S00.43) Right, left, unspecified Open wound of thyroid gland (S11.1) Laceration with foreign body of thyroid gland (S11.12) X – placeholder Multiple fracture of ribs (S22.4) Multiple fracture of ribs, right side (S22.41) X – placeholder Subluxation and dislocation of lumbar vertebra (S33.1) Subluxation and dislocation of L4/L5 lumbar vertebra (S33.14) Select subluxation or dislocation Position 6 5: often a specific nature of injury (often associated with 3; e.g., from open to puncture); sometimes a cause code (e.g., bite) 6: often a more specific region or nature of injury, placeholder or LOC

16. ICD9CM codeDescriptionICD10CM main code Description 820Fracture of neck of femurS72.0Fracture of head and neck of femur S72.1Pertrochanteric fracture S72.2Subtrochanteric fracture of femur S79.0Physeal fracture of upper end of femur Health and Safety Data Services Y93.D1 Actively knitting and crocheting Measure twice, cut once!Cookie fatigue, Santa? T73.3xxS Exhaustion due to excessive exertion

17. Health and Safety Data Services ICD9CM main code DescriptionICD10CM main code Description5:6:Possible ICD10CM code 852Subarachnoid, subdural and extradural hemorrhage S06.4Epidural hemorrhage x0-9S06.4x3A Epidural hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes 1: S 2: Head 3: Muscle and tendons + some organs 4: From head to epidural (often a subsection of 2) 5: Placeholder (often a subsection of 3) 6: LOC duration Epidural Hematoma with LOC

18. ICD9CM codeDescriptionICD10CM main code Description 820Fracture of neck of femurS72.0Fracture of head and neck of femur S72.1Pertrochanteric fracture S72.2Subtrochanteric fracture of femur S79.0Physeal fracture of upper end of femur Health and Safety Data Services ICD9CM code DescriptionICD10CM code Description 920Contusion of face, scalp, and neck except eye(s) S00.93XContusion of unspecified part of head S00.03Contusion of scalp S00.33Contusion of nose S00.43Contusion of ear S00.431Contusion of right ear S00.432Contusion of left ear S00.439Contusion of unspecified ear S00.53Contusion of lip and oral cavity S00.531Contusion of lip S00.532Contusion of oral cavity S00.83Contusion of other part of head S10.0Contusion of throat S10.83Contusion of other specified part of neck S10.93XContusion of unspecified part of neck Red = GEMS equivalent 1: chapter 2: major body region 3: major nature of injury 4: specific body region (often a subsection of 2 ; e.g., from head to scalp) 5: specific nature of injury (often a subsection of 3; e.g., superficial to contusion) 6: often a placeholder, location, or more injury specificity Contusion in Head or Neck Region

19. ICD9CM codeDescriptionICD10CM main code Description 820Fracture of neck of femurS72.0Fracture of head and neck of femur S72.1Pertrochanteric fracture S72.2Subtrochanteric fracture of femur S79.0Physeal fracture of upper end of femur Health and Safety Data Services Type of encounter* A: Initial encounter Active treatment, ER encounter, evaluation and treatment by a new physician D: Subsequent encounter Routine care during healing/recovery phase (e.g., cast change/removal, removal of external fixation device, planned follow-up visits) S: Sequela Complications or conditions that arise as a direct result of the injury (e.g., scar from burn) – Sequela replaced the late effects categories (905-909) in ICD9CM – Only used with the injury code where the sequela exists *with the exception of fractures Episode of Care - Position 7

20. ICD9CM codeDescriptionICD10CM main code Description 820Fracture of neck of femurS72.0Fracture of head and neck of femur S72.1Pertrochanteric fracture S72.2Subtrochanteric fracture of femur S79.0Physeal fracture of upper end of femur Health and Safety Data Services Position 7 - Fractures AInitial encounter for closed fracture BInitial encounter for open fracture DSubsequent encounter for fracture with routine healing GSubsequent encounter for fracture with delayed healing KSubsequent encounter for fracture with nonunion PSubsequent encounter for fracture with malunion SSequela Note: In ICD-10-CM, a fracture not indicated as displaced or nondisplaced should be coded to displaced, and a fracture not designated as open or closed should be coded as closed. Type of encounter ** **for use with fractures only

21. ICD9CM codeDescriptionICD10CM main code Description 820Fracture of neck of femurS72.0Fracture of head and neck of femur S72.1Pertrochanteric fracture S72.2Subtrochanteric fracture of femur S79.0Physeal fracture of upper end of femur Health and Safety Data Services Position 7 – OPEN Fractures BInitial encounter for open fracture type I or II CInitial encounter for open fracture type IIIA, IIIB, IIIC ESubsequent encounter for open fracture type I or II with routine healing FSubsequent encounter for open fracture type IIIA, IIIB, IIIC with routine healing HSubsequent encounter for open fracture type I or II with delayed healing JSubsequent encounter for open fracture type IIIA, IIIB, IIIC with delayed healing MSubsequent encounter for open fracture type I or II with nonunion NSubsequent encounter for open fracture type IIIA, IIIB, IIIC with nonunion QSubsequent encounter for open fracture type I or II with malunion RSubsequent encounter for open fracture type IIIA, IIIB, IIIC with malunion Apply to categories: S52 – Fracture of forearm S72 – Fracture of femur S82 – Fracture of lower leg Type of encounter *** ***for with open fractures only Gustilo open fracture classification

22. ICD9CM codeDescriptionICD10CM main code Description 820Fracture of neck of femurS72.0Fracture of head and neck of femur S72.1Pertrochanteric fracture S72.2Subtrochanteric fracture of femur S79.0Physeal fracture of upper end of femur Health and Safety Data Services

23. ICD9CM codeDescriptionICD10CM main code Description 820Fracture of neck of femurS72.0Fracture of head and neck of femur S72.1Pertrochanteric fracture S72.2Subtrochanteric fracture of femur S79.0Physeal fracture of upper end of femur Health and Safety Data Services For More Information Scott Beckley, PhD Health Facilities and EMS Division Colorado Department of Public Health & Environment 4300 Cherry Creek Drive South Denver, CO 80246-1530 scott.beckley@state.co.us P: (303) 692-2851 F: (303) 691-7720 www.coems.info