Top Codes by Cost Tip Sheet: ICD-10 Chapter Overview - BCBSM

Top Codes by Cost Tip Sheet: ICD-10 Chapter Overview

Chapter 19 - Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88)

Key Updates Injuries are grouped by body part rather than category of injury as they were in ICD-9-CM. Laterality is specified in this chapter. ICD-10-CM introduces a 7th character requirement that describes the type of encounter.

Most categories in this chapter use the 7th character requirement. Most categories in this chapter (see below for fractures) have three 7th character values of:

A - Initial encounter D - Subsequent encounter S - Sequela For traumatic fractures, there are additional 7th character requirements depending

upon the type of fracture, and complication. Some of these character descriptions are based on the Gustilo open fracture classification. Codes for underdosing are new in ICD-10-CM. Underdosing refers to taking less of a medication than is prescribed by a provider or less than the manufacturer's instructions. Codes for underdosing should not be assigned as principal or first-listed codes.

Chapter 21 - Factors Influencing Health Status and Contact with Health Services (Z00Z99)

Key Updates These codes are used in any healthcare setting. Z codes may be used as either a first-

listed or principal diagnosis code in the inpatient setting, or secondary code, depending on the circumstances of the encounter. Certain Z codes may only be used as first- listed or principal diagnosis in certain situations. Refer to Official Coding Guidelines for details. Z codes are not procedure codes. A corresponding procedure code must accompany a Z code to describe any procedure performed.

(Source: 2015 Draft ICD-10-CM Official Guidelines for Coding and Reporting)

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The top 25 codes by cost in ICD-9 to ICD-10 mappings are found in the chart below.

Top 25

ICD-9 Code

1 851.54

ICD-9 Description

Cerebellar or brain stem contusion w/open intracranial wound w/prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level

ICD-10 Code

S01.90XA

S06.375A

S06.385A

ICD-10 Description

Unspecified open wound of unspecified part of head, initial encounter Contusion, laceration, and hemorrhage of cerebellum w/loss of consciousness greater than 24 hours w/return to pre-existing conscious level, initial encounter Contusion, laceration, and hemorrhage of brainstem w/loss of consciousness greater than 24 hours w/return to pre-existing conscious level, initial encounter

2

854.14 Intracranial injury of other and

unspecified nature w/open

intracranial wound,

w/prolonged (more than 24

hours) loss of consciousness

and return to pre-existing

Unspecified open wound of unspecified part

conscious level

S01.90XA of head, initial encounter

Other specified intracranial injury with loss

of consciousness greater than 24 hours with

return to pre-existing conscious level, initial

S06.895A encounter

Other multiple birth (three or

more), mates liveborn and

3

V36.00 stillborn, born in hospital,

delivered without mention of

cesarean delivery

Z38.61

Triplet liveborn infant, delivered vaginally

Quadruplet liveborn infant, delivered

Z38.63

vaginally

Quintuplet liveborn infant, delivered

Z38.65

vaginally

Other multiple liveborn infant, delivered

Z38.68

vaginally

Other multiple liveborn infant, unspecified

Z38.8

as to place of birth

Closed fracture of base of skull

with other and unspecified

4

801.33 intracranial hemorrhage, with

moderate [1-24 hours] loss of

Unspecified fracture of base of skull, initial

consciousness

S02.10XA encounter for closed fracture

S06.363A

2

Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of 1 hours to 5 hours 59 minutes, initial encounter

Top 25

ICD-9 Code

ICD-9 Description

ICD-10 Code

S06.364A

Other closed skull fracture

w/subarachnoid,subdural,

extradural hemorrhage,

5 803.24 w/prolonged (more than 24

hours) loss of consciousness

and return to pre-existing

conscious level

S02.91XA

S06.4X5A

S06.5X5A

S06.6X5A

Closed fracture of base of skull

6

801.03

w/o mention of intracranial injury w/moderate, (1-24

hours) loss of consciousness S02.10XA

Other and unspecified cerebral

laceration and contusion,

without mention of open

7

851.85

intracranial wound, w/prolonged (more than 24

hours) loss of consciousness

w/o return to pre-existing

conscious level

S06.316A

S06.317A

S06.318A

S06.326A

S06.328A

S06.336A

ICD-10 Description Traumatic hemorrhage of cerebrum, unspecified,w/ loss of consciousness of 6 hours to 24 hours, initial encounter

Unspecified fracture of skull, initial encounter for closed fracture Epidural hemorrhage w/loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter Traumatic subdural hemorrhage w/loss of consciousness greater than 24 hours w/return to pre-existing conscious level, initial encounter Traumatic subarachnoid hemorrhage w/loss of consciousness greater than 24 hours w/return to pre-existing conscious level, initial encounter

Unspecified fracture of base of skull, initial encounter for closed fracture

Contusion and laceration of right cerebrum w/loss of consciousness greater than 24 hours w/o return to pre-existing conscious level w/patient surviving, initial encounter Contusion and laceration of right cerebrum w/loss of consciousness of any duration w/death due to brain injury prior to regaining consciousness, initial encounter Contusion and laceration of right cerebrum w/loss of consciousness of any duration w/death due to other cause prior to regaining consciousness, initial encounter Contusion and laceration of left cerebrum w/loss of consciousness greater than 24 hours w/o return to pre-existing conscious level w/patient surviving, initial encounter Contusion and laceration of left cerebrum w/loss of consciousness of any duration w/death due to other cause prior to regaining consciousness, initial encounter Contusion and laceration of cerebrum,unspecified, w/loss of consciousness greater than 24 hours w/o return to pre-existing conscious level w/patient surviving, initial encounter

3

Top 25

ICD-9 Code

ICD-9 Description

ICD-10 Code

S06.337A

S06.338A

8

806.16

Open fracture of C5-C7 level

w/complete lesion of cord

S12.400B

S12.401B S12.500B

S12.501B

S12.600B

S12.601B

S14.115A

S14.116A

S14.117A

Closed fracture of vault of

skull w/cerebral laceration

9

800.15

and contusion, w/prolonged (more than 24 hours) loss of

consciousness w/o return to

pre-existing conscious level S02.0XXA

S06.336A

S06.337A

S06.338A

Other closed skull fracture

w/cerebral laceration and

contusion, w/loss of

consciousness of unspecified

10

803.16 duration

S02.91XA

4

ICD-10 Description Contusion and laceration of cerebrum, unspecified, w/loss of consciousness of any duration w/death due to brain injury prior to regaining consciousness, initial encounter Contusion and laceration of cerebrum,unspecified, w/loss of consciousness of any duration w/death due to other cause prior to regaining consciousness, initial encounter Unspecified displaced fracture of fifth cervical vertebra, initial encounter for open fracture Unspecified nondisplaced fracture of fifth cervical vertebra, initial encounter for open fracture Unspecified displaced fracture of sixth cervical vertebra, initial encounter for open fracture Unspecified nondisplaced fracture of sixth cervical vertebra, initial encounter for open fracture Unspecified displaced fracture of seventh cervical vertebra, initial encounter for open fracture Unspecified nondisplaced fracture of seventh cervical vertebra, initial encounter for open fracture Complete lesion at C5 level of cervical spinal cord, initial encounter Complete lesion at C6 level of cervical spinal cord, initial encounter Complete lesion at C7 level of cervical spinal cord, initial encounter

Fracture of vault of skull, initial encounter for closed fracture Contusion and laceration of cerebrum, unspecified, w/loss of consciousness greater than 24 hours w/o return to pre-existing conscious level w/patient surviving, initial encounter Contusion and laceration of cerebrum, unspecified, w/loss of consciousness of any duration w/death due to brain injury prior to regaining consciousness, initial encounter

Contusion and laceration of cerebrum, unspecified, w/loss of consciousness of any duration w/death due to other cause prior to regaining consciousness, initial encounter

Unspecified fracture of skull, initial encounter for closed fracture

Top 25

ICD-9 Code

ICD-9 Description

ICD-10 Code

S06.339A

Injury to ascending (right)

colon, w/ open wound into

11

863.51 cavity

S316.09A

S36.500A

Cerebellar or brain stem

laceration w/o mention of

open intracranial

wound,w/prolonged (more

than 24 hours) loss of

consciousness w/o return to

12

851.65 pre-existing conscious level S06.376A

S06.377A

S06.378A

S06.386A

S06.387A

S06.388A

13

967.2

Poisoning by paraldehyde T42.6X1A

T42.6X2A

T42.6X3A

T42.6X4A

Other open skull fracture

w/intracranial injury of other

& unspecified nature, w/ loss

of consciousness of

14

803.96 unspecified duration

S02.91XB

S06.899A

ICD-10 Description Contusion and laceration of cerebrum, unspecified,w/loss of consciousness of unspecified duration, initial encounter Unspecified open would of abdominal wall, unspecified quadrant w/ penetration into peritoneal cavity, initial encounter Unspecified injury of ascending (right) colon, initial encounter

Contusion, laceration and hemorrhage of cerebellum w/loss of consciousness greater than 24 hours w/o return to pre-existing conscious level w/patient surviving, initial encounter Contusion, laceration and hemorrhage of cerebellum w/loss of consciousness of any duration w/death due to brain injury prior to regaining consciousness, initial encounter Contusion, laceration and hemorrhage of cerebellum w/loss of consciousness of any duration w/death due to other cause prior to regaining consciousness, initial encounter Contusion, laceration and hemorrhage of brainstem w/loss of consciousness greater than 24 hours w/o return to pre-existing conscious level w/patient surviving, initial encounter Contusion, laceration and hemorrhage of brainstem w/loss of consciousness of any duration w/death due to brain injury prior to regaining consciousness, initial encounter Contusion, laceration and hemorrhage of brainstem w/loss of consciousness of any duration w/death due to other cause prior to regaining consciousness, initial encounter Poisoning by other antiepileptic & sedativehypnotic drugs,accidental(unintentional), initial encounter Poisoning by other antiepileptic & sedativehypnotic drugs,intentional self-harm, initial encounter Poisoning by other antiepileptic & sedativehypnotic drugs,assault, initial encounter Poisoning by other antiepileptic & sedativehypnotic drugs,undetermined, initial encounter

Unspecified fracture of skull,initial encounter for open fracture

Other specified intracranial injury w/loss of consciousness of unspecified duration,initial encounter

5

Top 25

ICD-9 Code

15

V34.01

16

804.25

Top 25 ICD-9

ICD-9 Description

Other multiple birth(three or more),mates all liveborn,born in hospital, delivered by cesarean section

Closed fracture involving skull or face w/other bones w/subarachnoid, subdural & extradural hemorrhage w/prolonged (more than 24 hours) loss of consciousness/o return to pre-existing conscious level

ICD-10 Code S06.9X9A Z38.62 Z38.64 Z38.66 Z38.69

S02.91XA S06.4X6A S06.4X7A S06.4X8A S06.5X6A S06.5X7A S06.5X8A S06.6X6A S06.6X7A S06.6X8A

ICD-10 Description Unspecified intracranial injury w/loss of consciousness of unspecified duration, initial encounter

Triplet liveborn infant, delivered by cesarean Quadruplet liveborn infant, delivered by cesarean Quintuplet liveborn infant, delivered by cesarean Other multiple liveborn infant, delivered by cesarean

Unspecified fracture of skull,initial encounter for closed fracture Epidural hemorrhage w/loss of consciousness greater than 24 hours w/o return to pre-existing conscious level,w/patient surviving, initial encounter Epidural hemorrhage w/loss of consciousness of any duration w/death due to brain injury prior to regaining consciousness, initial encounter Epidural hemorrhage w/loss of consciousness of any duration w/death due to other causes prior to regaining consciousness, initial encounter Traumatic subdural hemorrhage w/loss of consciousness greater than 24 hours w/o return to pre-existing conscious level w/ patient surviving, initial encounter Traumatic subdural hemorrhage w/loss of consciousness of any duration w/death due to brain injury before regaining consciousness, initial encounter Traumatic subdural hemorrhage w/loss of consciousness of any duration w/death due to other cause before regaining consciousness, initial encounter Traumatic subarachnoid hemorrhage w/loss of consciousness greater than 24 hours w/o return to pre-existing conscious level w/patient surviving, initial encounter Traumatic subarachnoid hemorrhage w/loss of consciousness of any duration w/death due to brain injury prior to regaining consciousness, initial encounter Traumatic subarachnoid hemorrhage w/loss of consciousness of any duration w/death due to other cause prior to regaining consciousness, initial encounter

ICD-9 Description

ICD-10

6

ICD-10 Description

Code

Code

Other multiple birth (three or

more),unspecified whether

mates liveborn or stillborn, born

in hospital, delivered by

Triplet liveborn infant, delivered by cesarean

17

V37.01 cesarean delivery

Z38.62

section

Quadruplet liveborn infant, delivered by

Z38.64

cesarean

Quintuplet liveborn infant, delivered by

Z38.66

cesarean

Other multiple liveborn infant, delivered by

Z38.69

cesarean

Other multiple liveborn infant, unspecified as to

Z38.8

place of birth

Open fracture of vault of skull

w/subarachnoid, subdural, &

extradural hemorrhage, w/ no

Fracture of vault of skull, initial encounter for

18

800.71 loss of consciousness

S02.0XXB open fracture

Epidural hemorrhage w/o loss of

S06.4X0A consciousness, initial encounter

Traumatic subdural hemorrhage w/o loss of

S06.5X0A consciousness, initial encounter

Traumatic subarachnoid hemorrhage w/o loss

S06.6X0A of consciousness, initial encounter

Other multiple birth(three or

more),mates liveborn and

stillborn,born in hospital

delivered by cesarean

Triplet liveborn infant, delivered by cesarean

19

V36.01 delivery

Z38.62

section

Quadruplet liveborn infant, delivered by

Z38.64

cesarean

Quintuplet liveborn infant, delivered by

Z38.66

cesarean

Other multiple liveborn infant, delivered by

Z38.69

cesarean

Other multiple liveborn infant, unspecified as to

Z38.8

place of birth

Closed fracture of base of

skull w/cerebral laceration &

contusion,w/ concussion,

Unspecified fracture of base of skull, initial

20

801.19 unspecified

S02.10XA encounter for closed fracture

Contusion & laceration of

cerebrum,unspecified,w/o loss of

S06.330A consciousness, initial encounter

Injury to multiple sites in

colon & rectum, w/o mention

Unspecified injury of other part of colon, initial

21

863.46 of open wound into cavity

S36.508A encounter

Primary blast injury of other part of colon, initial

S36.518A encounter

Contusion of other part of colon, initial

S36.528A encounter

Laceration of other part of colon, initial

S36.538A encounter

Other injury of other part of colon, initial

S36.598A encounter

Other open skull fracture

w/subarachnoid, subdural,

extradural hemorrhage w /loss of

consciousness of unspecified

Unspecified fracture of skull, initial encounter

22

803.76 duration

S02.91XB for open fracture

7

Top 25

ICD-9 Code

23

286.1

24

V31.1

25

803.61

ICD-9 Description

Congenital factor IX disorder Twin birth, mate liveborn, born before admission to hospital Other open skull fracture w/cerebral laceration & contusion,w/no loss of consciousness

ICD-10 Code S06.4X9A

S06.5X9A

S06.6X9A

ICD-10 Description Epidural hemorrhage w/loss of consciousness of unspecified duration, initial encounter Traumatic subdural hemorrhage w/loss of consciousness of unspecified duration, initial encounter Traumatic subarachnoid hemorrhage w/loss of consciousness of unspecified duration, initial encounter

D67

Hereditary factor IX deficiency

Z38.4

Twin liveborn infant, born outside hospital

S02.91XB S06.330A

Unspecified fracture of skull, initial encounter for open fracture Contusion & laceration of cerebrum,unspecified, w/o loss of consciousness, initial encounter

The codes highlighted in orange indicate the individual ICD-9 code that is being mapped to one or many ICD-10 codes

(Source of ICD-9-CM to ICD-10-CM mappings: General Equivalence Mappings (GEMs), 2015)

The information in this document is not intended to impart legal advice. This overview is intended as an educational tool only and should not be relied upon as legal or compliance advice. If you have any legal questions about the information contained herein, you should consult your attorney or other professional legal services provider.

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