ICD-10 Q&A
Disclaimer: All of the ICD-10 codes within this document were chosen by PTSF registry staff and reflect our opinion of the best code using standard ICD-10-CM/PCS guidelines and coding norms. As all good coders and trauma registrars do, you are more than welcome to disagree with any of the information contained in this document.
*PTSF staff submitted questions to Coding Clinic in early 2016. As of 10/6/2016, PTSF has still not received any responses from Coding Clinic. If responses are received, answers will be updated appropriately. Thank you for your patience! Questions awaiting a response from Coding Clinic are highlighted in yellow.
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(10/7/2016)
Q. Are there specific PCS codes for CTAs and MRAs? If not, how should these be coded? For example, should table BW2 be used for both CT and CTA of the head and neck?
Answer: The answer to this question was provided by AHIMA’s Code-Check. Please see below:
Question Response:
Based on the scenario provided, and without the de-identified medical records for documentation review, it is not possible to definitively recommend the accuracy of ICD-10-PCS assignment, with certainty. Advice is provided from a general and hypothetical standpoint.
There are specific PCS codes for CTAs and MRAs.
Root Operation for CTAs and MRAs is Imaging.
BW2 would be used for both CT and CTA of the head and neckwith body part ‘9’ for head and neck per the BW2 PCS table.
The 2nd character of W can be used when the specific body part is not specified – see PCS coding guideline Medical and Surgical Section, Body System, B2.1.a.
The 3rd character defines procedure by root type, instead of root operation. Root type for CTA is 2.
This also applies with MRAs, with 3rd character of 3 for Angiography MRI.
Rationale for recommended coding assignment:
Imaging—Section B
Imaging follows the same conventions established in the Medical and Surgical section, for the section, body system, and body part characters. However, the third and fourth characters introduce definitions not used in previous sections.
•Third character defines procedure by root type, instead of root operation.
•Fifth character defines contrast if used. ICD-10-PCS Reference Manual
- Sixth character is a qualifier that specifies an image taken without contrast followed by one with contrast.
•Seventh character is a qualifier that is not specified in this section.
The Imaging root types are defined below:
0 – Plain Radiography: Planar display of an image developed from the capture of external ionizing radiation on photographic or photoconductive plate
1 – Fluoroscopy: Single plane or bi-plane real time display of an image developed from the capture of external ionizing radiation on a fluorescent screen. The image may also be stored by either digital or analog means
2 – Computerized Tomography (CT scan): Computer reformatted digital display of multiplanar images developed from the capture of multiple exposures of external ionizing radiation
3 – Magnetic Resonance Imaging (MRI): Computer reformatted digital display of multiplanar images developed from the capture of radio-frequency signals emitted by nuclei in a body site excited within a magnetic field
4 – Ultrasonography: Real time display of images of anatomy or flow information developed from the capture of reflected and attenuated high frequency sound waves
ICD-10 PCS Guideline:
Medical and Surgical Section Guidelines (section 0)
B2. Body System
B2.1a
The procedure codes in the general anatomical regions body systems can be used when the procedure is performed on an anatomical region rather than a specific body part (e.g., root operations Control and Detachment, Drainage of a body cavity) or on the rare occasion when no information is available to support assignment of a code to a specific body part.
Examples: Control of postoperative hemorrhage is coded to the root operation Control found in the general anatomical regions body systems.
Chest tube drainage of the pleural cavity is coded to the root operation Drainage found in the general anatomical regions body systems. Suture repair of the abdominal wall is coded to the root operation Repair in the general anatomical regions body system.
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(10/6/2016)
Q. What is the correct code for fall from trampoline?
Answer: The correct ICD-10-CM code in this situation is W17.89XA, other fall from one level to another. Although PTOS does not require activity codes to be captured, activity code Y93.44, activity, trampolining, may accompany the mechanism of injury code to help explain the circumstances of the fall.
Q. What is the correct code for closed head injury with no LOC information?
Answer: The correct ICD-10-CM code in this situation is S09.90XA, unspecified injury of head.
Q. What type of transport vehicle does dirt bike fall under?
Answer: Dirt bike falls under special all-terrain or other off-road motor vehicle. For example, V86.59XA would be the correct ICD-10-CM code for a driver of a dirt bike injured in a nontraffic accident.
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(8/2/2016)
Q. What code should be used for a patient that was shot with a crossbow by her husband?
Answer: “Contact with arrow” directs you to W21.89, striking against or struck by other sports equipment. However, the excludes note at the beginning of category W21 directs you to Y08.0 for assault with sports equipment. PTSF staff recommends using Y08.09XA, assault by strike by other specified type of sport equipment, in this situation.
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(6/29/2016)
Q. Is there an ICD-10 code for ECMO?
Answer: PTSF staff recommends 5A15_23 (Extracorporeal Assistance and Performance, Physiological Systems, Performance, Circulatory, Duration (space holder), Oxygenation, Membrane).
Q. PT working as a trash collector riding on the rear step on the passenger side of the trash truck. As the driver was traveling on avenue, the Pt was knockedoff of the truck by a tree on the side of the road and fell to the ground. Pt's hip struck the textured metal step that he was standing on during his fall, causing the laceration to the hip. What ICD-10 code should be used?
Answer: PTSF staff recommends V68.7XXA (person on outside of heavy transport vehicle injured in noncollision transport accident in traffic accident).
Q. Patient was being chased by police, crashed his MV and then jumped from overpass to avoid police. The patient fell 60 feet landing on dry creek bed. What ICD-10 code should be used?
Answer: ICD-10 defines legal intervention as “any injury sustained as a result of an encounter with any law enforcement official, serving in any capacity at the time of the encounter, whether on-duty or off-duty. Includes: injury to law enforcement official, suspect and bystander.” Even though the patient was being the chased by law enforcement at the time of injury, PTSF staff recommends utilizing Y30.XXXA (falling, jumping or pushed from high place, undetermined intent) or W13.8XXA (fall from, out of or through other building or structure). Select the best code based on your documentation.Undetermined intent is only used when there is specific documentation in the record that the intent of the injury cannot be determined. If no such documentation is present, code to accidental (unintentional). A legal intervention code of Y35.893A (legal intervention involving other specified means, suspect injured) may be coded as a secondary code.
Q. Patient jumped from overpass (do not know if intentional or not) and fell 60 feet landing on dry creek bed. What ICD-10 code should be used?
Answer: Undetermined intent is only used when there is specific documentation in the record that the intent of the injury cannot be determined. If no such documentation is present, code to accidental (unintentional). Utilize Y30.XXXA (falling, jumping or pushed from high place, undetermined intent) if your situation meets the above criteria for coding undetermined intent. If no such documentation is present to code undetermined intent, utilize W13.8XXA (fall from, out of or through other building or structure).
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(5/31/2016)
Q. Do you by chance know of an ICD-10 code that could be used for REBOA?
Answer: PTSF staff recommends coding 04L0_DZ if the occlusion is at the abdominal aorta. PTSF staff could not find a code for occlusion at the thoracic aorta.
Q. A patient was injured by bumping up against the sides of a waterslide on the way down. What should I use for Primary ICD 10 Mechanism field?
Answer: PTSF staff recommends coding W22.09XA (striking against other stationary object) in this situation.
Q. A patient was injured upon impact with water at the bottom of a waterslide. What should I use for Primary ICD 10 Mechanism field?
Answer: PTSF staff recommends coding W16.012A (fall into swimming pool striking water surface causing other injury) in this situation.
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(5/9/2016)
Q. For a FAST exam, PTSF staff has recommended using BW41ZZZ if the ICD-9 code previously used was 88.79. If the ultrasound is done only to check for cardiac motion in a patient presumably dead on arrival to the ED and no abdominal imaging is done, should this code also be used in that case, or should it be B246ZZZ, which is more in line with an echocardiogram?
Answer: PTSF staff recommends that you only code the B24 code in this situation.
Q. For patients who undergo wound irrigation and debridement, should both OHB/OJB (debridement, depending on location) and 3E10X8Z (irrigation) be coded, or is the irrigation already part of the debridement?
Answer: PTSF staff recommends only coding the debridement; however, the PTSF has also submitted this question to Coding Clinic for guidance.
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(4/27/2016)
Q. An operative report contains the following procedures: fiberoptic bronchoscopy, bronchoalveolar lavage with bacterial culture and transbronchial needle aspirations of the R paratracheal LN. How should these procedures be coded?
Answer: PTSF staff recommends that the bronchoscopy (OBJ08ZZ) not be coded in addition to the lavage. This information can be used for the approach. The bronchoalveolar lavage with bacterial culture should be coded to 0B9_8ZX. The fourth character will specify the body part. Remember you will have to use two codes, one for left and one for right if applicable. The needle biopsy of R paratracheal lymph node should be coded to the root operation excision. PTSF staff recommends recording ICD-10-PCS code 07B73ZX.
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(4/12/2016)
Q. What is the ICD-10 procedure code for occlusion of VP shunt occluded at the clavicle level?
Answer: PTSF staff determined that this procedure is not able to be coded in ICD-10. Placement of a VP shunt should be coded to 0016_ _6; however, there is no ICD-10 code for the occlusion.
Q. What is the correct ICD-10 procedure code for amputation of left hand at PIP joint 5th digit?
Answer: PTSF staff recommends code 0X6W0Z2 (detachment, little finger left, open, no device, mid) in this situation.
Q. When looking at table 0X6 in ICD-10-PCS, what does 7th character qualifier of high, mid and low mean?
Answer: High=proximal, Mid=middle, and Low=distal.
Q. When looking at table 0X6 in ICD-10-PCS, what does 7th character qualifier of complete and partial rays mean?
Answer: 7th character qualifier definitions for complete and partial rays can be found on the table at the beginning of the Upper Extremity section. This table is on page 551 of the 2016 Optum ICD-10-PCS coding book.
Q. What is the correct ICD-10 code for a child riding on the back of a powerwheelstruck that brother is driving, falls off the back, and strikes her head on concrete?
Answer: PTSF staff recommends code V00.891A, fall from other pedestrian conveyance, be used in this situation.
Q. A patient was working on a mining machine when it caught fire. He jumped from the machinery and suffered traumatic injuries.What is the correct ICD-10 code?
Answer: Jumping from machinery should be coded to fall from machinery. Fall from machinery gets coded to contact with machinery. PTSF staff recommends code W31.0XXA in this situation.
Q. What is the correct ICD-10 mechanism code for a patient that was injured while being helped by transport personnel? Transport personnel grabbed the patient around her trunk and tried to lift and reposition her. Admission for rib fractures x2 and pain control.
Answer: PTSF staff recommend W50.2XXA in this situation. The lifting of a person for transport should not be considered medical or surgical care.
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(3/17/2016)
Q. When coding the craniotomy/burr hole procedure, is there any additional code needed if the patient has a subdural drain left in after surgery?
Answer: Craniotomy of the subdural space should be coded to 0094_0Z. Be sure to select 0 for the sixth character in this situation. Since character 6 is drainage device, no additional code is needed if a subdural drain is left in after surgery. Please note that table 009 takes up multiple pages. Be certain you are on the correct page of table 009 in ICD-10-PCS.
Q. When coding meniscectomy, what is the most appropriate code? Table OSB or table OST?
Answer: The alphabetic index of ICD-10-PCS directs users to table 0SB when looking up the main term meniscectomy. Table OSB (excision) should be used since the meniscus is a portion of the knee joint.
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(3/10/2016)
Q. List B of the PTOS Manual codes FAST exam to BW40ZZZ. Would BW41ZZZ fit better?
Answer: There is not a specific code for FAST in ICD-10. PTSF staff recommends coding BW40ZZZ and the appropriate code from table B24 based on your documentation. If your documentation states the FAST was extended to the pelvis, you may use BW41ZZZ instead of BW40ZZZ. Per the American College of Emergency Physicians (ACEP), there is no single, defined code for the clinical FAST exam. Rather, the exam is reportable as either two or three distinct limited ultrasound examinations. The cardiac component of the exam is coded to transthoracic echocardiogram. The abdominal component of the exam is coded to abdominal ultrasound. The thoracic component (e.g. hemothorax or pneumothorax evaluation, if performed) of the exam is coded to chest ultrasound. The PTOS manual will be updated accordingly.
Q. Should code 0WJP7ZZ be coded for re-exploratory laparotomy?
Answer: PTSF staff agrees with code 0WJP7ZZ.
Q. What procedure code would we use if there were no procedures done during the patient’s stay?
Answer: If no procedures are performed during the acute care phase, please select ‘n/a’ from procedure code drop-down. Please refer to page 95 of the 2016 PTOS manual.
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(3/3/2016)
Q. If a patient receives a CT scan with contrast and a CT scan without contrast of a specified body part, does PTOS still only want the first CT per body region or both since they are different codes?
Answer: In 2017, List B Procedures within the PTOS manual will be revised to state, “1x per ICD-10 code” prior to the required CTs. Since the PCS code for CTs with contrast and without contrast are different, record both. (Updated 10/6/2016)
Q. A young child puts a piece of a plastic toy in his mouth, is running, falls and the plastic toy strikes the back of the patient’s throat. What is the correct mechanism of injury code?
Answer: In this situation, PTSF staff recommends W01.198A (fall on same level from slipping, tripping and stumbling with subsequent striking against other object).
Q. What is the correct code for a patient that has hurt themselves by “stretching” or doing “strenuous movements?”
Answer: In this situation, PTSF staff recommends X58.XXXA (exposure to other specified factors, accident NOS).
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(2/23/16)
Q. When coding central lines, are we to code where the line was inserted (right jugular) or where the tip terminates (superior vena cava)?
Answer: Percutaneous placement of venous central line in right internal jugular, with tip in superior vena cava should be coded to 05HM33Z and 02HV33Z.
Q. How would you code right-sided frontotemporoparietal decompressive hemicraniectomy (burr holes) with evacuation of an acute subdural hematoma? Are we to only code the evacuation of the SDH?
Answer: In this situation, only the evacuation of the acute subdural hematoma needs to be coded (00940ZZ).
Q. What ICD-10 code would I use for ct pelvis, no contrast?
Answer: CT of the pelvis without contrast should be coded to BW2GZZZ (pelvic region), BR2CZZZ (pelvic bones only), or BW21ZZZ (pelvis and abdomen). Select the most appropriate code based on your documentation.
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(2/18/2016)
Q. What is the correct code for interosseous line placement of the R lower leg? Would you also code the infusion?
Answer: In this situation the PTSF recommends 0YHH33Z (insertion, R lower leg, percutaneous, infusion device) and 3E0A3GC (introduction, bone marrow, percutaneous, therapeutic substance, other substance). The PTSF has also submitted this question to Coding Clinic for guidance to determine if both codes should be coded.
Q. What is the correct code for a wound vac?
Answer: This is no code for wound vac in ICD-9 or ICD-10. You must code the procedure(s) performed, such as inspection.
Q. A patient was burned when Freon leaked out of a refrigerator and onto the patient’s skin. Is W93.8XXA the appropriate code? There is also a T code for Freon. Should this code be used? When is it appropriate to use a T code for the primary mechanism injury?
Answer: PTSF staff agrees that W93.8XXA is the appropriate code in this situation. The T code is not required in this situation, but may be recorded as the secondary mechanism. T codes can be recorded as the primary mechanism by coding guidelines.
Q. A patient was snowboarding at high speed and the board “kicked up” and hit the patient causing the patient to fall. Would this be coded to V00.311A (fall from snowboard) or V00318A (other snowboard accident)?
Answer: PTSF staff recommends V00.311A (fall from snowboard) in this situation.
Q. Is there a code for pelvic binders?
Answer: The PTSF recommends 0QS2XZZ and 0QS3XZZ. PTSF has also submitted this questions to Coding Clinic for further guidance.
Q. What is the correct code for CT AngioAbd and Pelvis w/wo Contrast?
Answer: ICD-10 does not seem to have specific codes for CTAs. PTSF staff has submitted this question to Coding Clinic and is awaiting a response. Once a response is received, it will be posted here.
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