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

Transcription

1 Top s by Cost Tip Sheet: 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 -CM. Laterality is specified in this chapter. -CM introduces a 7th character requirement that describes the type of. 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 D - Subsequent S - Sequela For traumatic fractures, there are additional 7 th character requirements depending upon the type of fracture, and complication. Some of these character descriptions are based on the Gustilo open fracture classification. s for underdosing are new in -CM. Underdosing refers to taking less of a medication than is prescribed by a provider or less than the manufacturer s instructions. s for underdosing should not be assigned as principal or first-listed codes. Chapter 21 - Factors Influencing Health Status and Contact with Health Services (Z00- Z99) Key Updates These codes are used in any healthcare setting. Z codes may be used as either a firstlisted or principal diagnosis code in the inpatient setting, or secondary code, depending on the circumstances of the. 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 -CM Official Guidelines for Coding and Reporting) 1

2 The top 25 codes by cost in to mappings are found in the chart below. Top 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 S01.90XA S06.375A S06.385A Description Unspecified open wound of unspecified part of head, initial Contusion, laceration, and hemorrhage of cerebellum w/loss of consciousness greater than 24 hours w/return to pre-existing conscious level, initial Contusion, laceration, and hemorrhage of brainstem w/loss of consciousness greater than 24 hours w/return to pre-existing conscious level, initial 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 conscious level 3 V S01.90XA S06.895A Unspecified open wound of unspecified part of head, initial Other specified intracranial injury with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial Other multiple birth (three or more), mates liveborn and stillborn, born in hospital, delivered without mention of delivery Z38.61 Triplet liveborn infant, delivered vaginally Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with moderate [1-24 hours] loss of consciousness Z38.63 Z38.65 Z38.68 Z38.8 S02.10XA Quadruplet liveborn infant, delivered vaginally Quintuplet liveborn infant, delivered vaginally Other multiple liveborn infant, delivered vaginally Other multiple liveborn infant, unspecified as to place of birth Unspecified fracture of base of skull, initial for closed fracture S06.363A Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of 1 hours to 5 hours 59 minutes, initial 2

3 Description Other closed skull fracture w/subarachnoid,subdural, extradural hemorrhage, w/prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level Closed fracture of base of skull w/o mention of intracranial injury w/moderate, (1-24 hours) loss of consciousness Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, w/prolonged (more than 24 hours) loss of consciousness w/o return to pre-existing conscious level S06.364A S02.91XA S06.4X5A S06.5X5A S06.6X5A S02.10XA S06.316A S06.317A S06.318A S06.326A S06.328A S06.336A Description Traumatic hemorrhage of cerebrum, unspecified,w/ loss of consciousness of 6 hours to 24 hours, initial Unspecified fracture of skull, initial for closed fracture Epidural hemorrhage w/loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial consciousness greater than 24 hours w/return to pre-existing conscious level, initial Traumatic subarachnoid hemorrhage w/loss of consciousness greater than 24 hours w/return to pre-existing conscious level, initial Unspecified fracture of base of skull, initial 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 Contusion and laceration of right cerebrum w/loss of consciousness of any duration w/death due to brain injury prior to regaining consciousness, initial Contusion and laceration of right cerebrum w/loss of consciousness of any duration w/death due to other cause prior to regaining consciousness, initial 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 Contusion and laceration of left cerebrum w/loss of consciousness of any duration w/death due to other cause prior to regaining consciousness, initial 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 3

4 Description Open fracture of C5-C7 level w/complete lesion of cord Closed fracture of vault of skull w/cerebral laceration and contusion, w/prolonged (more than 24 hours) loss of consciousness w/o return to pre-existing conscious level Other closed skull fracture w/cerebral laceration and contusion, w/loss of consciousness of unspecified duration S06.337A S06.338A S12.400B S12.401B S12.500B S12.501B S12.600B S12.601B S14.115A S14.116A S14.117A S02.0XXA S06.336A S06.337A S06.338A S02.91XA 4 Description unspecified, w/loss of consciousness of any duration w/death due to brain injury prior to regaining consciousness, initial Contusion and laceration of cerebrum,unspecified, w/loss of other cause prior to regaining consciousness, initial Unspecified displaced fracture of fifth cervical vertebra, initial for open fracture Unspecified nondisplaced fracture of fifth cervical vertebra, initial for open fracture Unspecified displaced fracture of sixth cervical vertebra, initial for open fracture Unspecified nondisplaced fracture of sixth cervical vertebra, initial for open fracture Unspecified displaced fracture of seventh cervical vertebra, initial for open fracture Unspecified nondisplaced fracture of seventh cervical vertebra, initial for open fracture Complete lesion at C5 level of cervical spinal cord, initial Complete lesion at C6 level of cervical spinal cord, initial Complete lesion at C7 level of cervical spinal cord, initial Fracture of vault of skull, initial for closed fracture unspecified, w/loss of consciousness greater than 24 hours w/o return to pre-existing conscious level w/patient surviving, initial unspecified, w/loss of consciousness of any duration w/death due to brain injury prior to regaining consciousness, initial unspecified, w/loss of consciousness of any duration w/death due to other cause prior to regaining consciousness, initial Unspecified fracture of skull, initial for closed fracture

5 Description Injury to ascending (right) colon, w/ open wound into cavity 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 pre-existing conscious level S06.339A S316.09A S36.500A S06.376A S06.377A S06.378A S06.386A S06.387A S06.388A Poisoning by paraldehyde T42.6X1A Other open skull fracture w/intracranial injury of other & unspecified nature, w/ loss of consciousness of unspecified duration T42.6X2A T42.6X3A T42.6X4A S02.91XB S06.899A Description unspecified,w/loss of consciousness of unspecified duration, initial Unspecified open would of abdominal wall, unspecified quadrant w/ penetration into peritoneal cavity, initial Unspecified injury of ascending (right) colon, initial cerebellum w/loss of consciousness greater than 24 hours w/o return to pre-existing conscious level w/patient surviving, initial cerebellum w/loss of consciousness of any duration w/death due to brain injury prior to regaining consciousness, initial cerebellum w/loss of consciousness of any duration w/death due to other cause prior to regaining consciousness, initial brainstem w/loss of consciousness greater than 24 hours w/o return to pre-existing conscious level w/patient surviving, initial brainstem w/loss of consciousness of any duration w/death due to brain injury prior to regaining consciousness, initial brainstem w/loss of consciousness of any duration w/death due to other cause prior to regaining consciousness, initial Poisoning by other antiepileptic & sedativehypnotic drugs,accidental(unintentional), initial Poisoning by other antiepileptic & sedativehypnotic drugs,intentional self-harm, initial Poisoning by other antiepileptic & sedativehypnotic drugs,assault, initial Poisoning by other antiepileptic & sedativehypnotic drugs,undetermined, initial Unspecified fracture of skull,initial for open fracture Other specified intracranial injury w/loss of consciousness of unspecified duration,initial 5

6 15 V Description S06.9X9A Description Unspecified intracranial injury w/loss of consciousness of unspecified duration, initial Other multiple birth(three or more),mates all liveborn,born in hospital, delivered by section Z38.62 Triplet liveborn infant, delivered by 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 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 Quadruplet liveborn infant, delivered by Quintuplet liveborn infant, delivered by Other multiple liveborn infant, delivered by Unspecified fracture of skull,initial 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 Epidural hemorrhage w/loss of consciousness of any duration w/death due to brain injury prior to regaining consciousness, initial Epidural hemorrhage w/loss of consciousness of any duration w/death due to other causes prior to regaining consciousness, initial consciousness greater than 24 hours w/o return to pre-existing conscious level w/ patient surviving, initial brain injury before regaining consciousness, initial other cause before regaining consciousness, initial Traumatic subarachnoid hemorrhage w/loss of consciousness greater than 24 hours w/o return to pre-existing conscious level w/patient surviving, initial Traumatic subarachnoid hemorrhage w/loss of brain injury prior to regaining consciousness, initial Traumatic subarachnoid hemorrhage w/loss of other cause prior to regaining consciousness, initial Top 25 Description Description 6

7 17 V V Other multiple birth (three or more),unspecified whether mates liveborn or stillborn, born in hospital, delivered by delivery Z38.62 Open fracture of vault of skull w/subarachnoid, subdural, & extradural hemorrhage, w/ no loss of consciousness Z38.64 Z38.66 Z38.69 Z38.8 S02.0XXB S06.4X0A S06.5X0A S06.6X0A Other multiple birth(three or more),mates liveborn and stillborn,born in hospital delivered by delivery Z38.62 Closed fracture of base of skull w/cerebral laceration & contusion,w/ concussion, unspecified Injury to multiple sites in colon & rectum, w/o mention of open wound into cavity Other open skull fracture w/subarachnoid, subdural, extradural hemorrhage w /loss of consciousness of unspecified duration Z38.64 Z38.66 Z38.69 Z38.8 S02.10XA S06.330A S36.508A S36.518A S36.528A S36.538A S36.598A S02.91XB 7 Triplet liveborn infant, delivered by section Quadruplet liveborn infant, delivered by Quintuplet liveborn infant, delivered by Other multiple liveborn infant, delivered by Other multiple liveborn infant, unspecified as to place of birth Fracture of vault of skull, initial for open fracture Epidural hemorrhage w/o loss of consciousness, initial Traumatic subdural hemorrhage w/o loss of consciousness, initial Traumatic subarachnoid hemorrhage w/o loss of consciousness, initial Triplet liveborn infant, delivered by section Quadruplet liveborn infant, delivered by Quintuplet liveborn infant, delivered by Other multiple liveborn infant, delivered by Other multiple liveborn infant, unspecified as to place of birth Unspecified fracture of base of skull, initial for closed fracture Contusion & laceration of cerebrum,unspecified,w/o loss of consciousness, initial Unspecified injury of other part of colon, initial Primary blast injury of other part of colon, initial Contusion of other part of colon, initial Laceration of other part of colon, initial Other injury of other part of colon, initial Unspecified fracture of skull, initial for open fracture

8 Description S06.4X9A S06.5X9A S06.6X9A Description Epidural hemorrhage w/loss of consciousness of unspecified duration, initial consciousness of unspecified duration, initial Traumatic subarachnoid hemorrhage w/loss of consciousness of unspecified duration, initial Congenital factor IX disorder D67 Hereditary factor IX deficiency 24 V31.1 Twin birth, mate liveborn, born before admission to hospital Z38.4 Twin liveborn infant, born outside hospital Other open skull fracture w/cerebral laceration & contusion,w/no loss of consciousness S02.91XB Unspecified fracture of skull, initial for open fracture S06.330A Contusion & laceration of cerebrum,unspecified, w/o loss of consciousness, initial The codes highlighted in orange indicate the individual code that is being mapped to one or many codes (Source of -CM to -CM mappings: CMS.org 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. 8