ICD-10: Exact Symptom Location Becomes a Huge Deal

Betsy Nicoletti, MS


July 02, 2015

In This Article

More Attention to Injuries

In addition to "location, location, location," "injuries are gonna hurt" is another mantra that relates to ICD-10. The largest increase in codes is in Chapter 19, "Injury, Poisoning and Certain Other Consequences of External Causes." There are a few reasons, two already discussed: The locations become more specific, and laterality is added to the description of many injuries.

There are also many more codes to describe complications of an injury. Is the wound with or without a foreign body? Does the puncture wound of the abdomen penetrate into the peritoneal cavity? And injuries require a seventh character extender. The most common extender indicates the episode of care: initial, subsequent, or sequela.

The same diagnosis code is used at each episode of care, with the appropriate seventh character. There are different seventh character extenders for fracture care. For a few fractures, the level of soft tissue damage is reported using the Gustilo scale. For most fractures, there are options for after care defined as routine healing, delayed healing, nonunion, or malunion. At the start of the category of code, the appropriate seventh characters for that category are listed.

Most electronic health records have a built-in translation program that will map codes from ICD-9 to ICD-10, and many medical providers are seeing these ICD-10 codes in their problem lists. Mapping or translation programs between ICD-9 and ICD-10 will be invaluable for clinicians.

However, any code that has increased location specificity or laterality will map to an unspecified code in ICD-10. For example, primary arthritis localized in the hand is coded as 715.14. This will map to M19.049, primary osteoarthritis, unspecified hand in ICD-10. There are specific codes M19.041 for primary osteoarthritis, right hand and M19.042 for primary osteoarthritis, left hand. There is no bilateral code. If the patient has arthritis in both hands, assign both codes. However, the automatic mapping will show the unspecified code because laterality is not described in ICD-9 diagnosis codes for arthritis. Some person, coder or clinician, will need to select a more specific code based on location for many diagnostic categories.


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