- Coding for Multiple Injuries
When coding multiple injuries such as fracture of tibia and fibula,
assign separate codes for each injury unless a combination code is provided, in which case
the combination code is assigned. Multiple injury codes are provided in ICD-9-CM, but
should not be assigned unless information for a more specific code is not available.
- The code for the most serious injury, as determined by the physician, is sequenced
- Superficial injuries such as abrasions or contusions are not coded when associated with
more severe injuries of the same site.
- When a primary injury results in minor damage to peripheral nerves or blood vessels, the
primary injury is sequenced first with additional code(s) from categories 950-957, Injury
to nerves and spinal cord, and/or 900-904, Injury to blood vessels. When the primary
injury is to the blood vessels or nerves, that injury should be sequenced first.
- Coding for Multiple Fractures
The principle of multiple coding of injuries should be followed in
coding multiple fractures. Multiple fractures of specified sites are coded individually by
site in accordance with both the provisions within categories 800-829 and the level of
detail furnished by medical record content. Combination categories for multiple fractures
are provided for use when there is insufficient detail in the medical record (such as
trauma cases transferred to another hospital), when the reporting form limits the number
of codes that can be used in reporting pertinent clinical data, or when there is
insufficient specificity at the fourth-digit or fifth-digit level. More specific
guidelines are as follows:
- Multiple fractures of same limb classifiable to the same three-digit or four-digit
category are coded to that category.
- Multiple unilateral or bilateral fractures of same bone(s) but classified to different
fourth-digit subdivisions (bone part) within the same three-digit category are coded
individually by site.
- Multiple fracture categories 819 and 828 classify bilateral fractures of both upper
limbs (819) and both lower limbs (828), but without any detail at the fourth-digit level
other than open and closed type of fractures.
- Multiple fractures are sequenced in accordance with the severity of the fracture and the
physician should be asked to list the fracture diagnoses in the order of severity.
- Current Burns and Encounters for Late Effects of Burns
Current burns (940-948) are classified by depth, extent and, if desired,
by agent (E code). By depth burns are classified as first degree (erythema), second degree
(blistering), and third degree (full-thickness involvement).
- All burns are coded with the highest degree of burn sequenced first.
- Classify burns of the same local site (three-digit category level, (940-947) but of
different degrees to the subcategory identifying the highest degree recorded in the
- Non-healing burns are coded as acute burns. Necrosis of burned skin should be coded as a
- Assign code 958.3, Posttraumatic wound infection, not elsewhere classified, as an
additional code for any documented infected burn site.
- When coding multiple burns, assign separate codes for each burn site. Category 946 Burns
of Multiple specified sites, should only be used if the location of the burns are not
documented. Category 949, Burn, unspecified, is extremely vague and should rarely be used.
- Assign codes from category 948, Burns classified according to extent of body surface
involved, when the site of the burn is not specified or when there is a need for
additional data. It is advisable to use category 948 as additional coding when needed to
provide data for evaluating burn mortality, such as that needed by burn units. It is also
advisable to use category 948 as an additional code for reporting purposes when there is
mention of a third-degree burn involving 20 percent or more of the body surface. In
assigning a code from category 948:
Fourth-digit codes are used to identify the percentage of total body surface
involved in a burn (all degree).
Fifth-digits are assigned to identify the percentage of body surface involved in
Fifth-digit zero (0) is assigned when less than 10 percent or when no body surface is
involved in a third-degree burn.
Category 948 is based on the classic "rule of nines" in estimating body
surface involved: head and neck are assigned nine percent, each arm nine percent, each leg
18 percent, the anterior trunk 18 percent, posterior trunk 18 percent, and genitalia one
percent. Physicians may change these percentage assignments where necessary to accommodate
infants and children who have proportionately larger heads than adults and patients who
have large buttocks, thighs, or abdomen that involve burns.
- Encounters for the treatment of the late effects of burns (i.e., scars or joint
contractures) should be coded to the residual condition (sequelae) followed by the
appropriate late effect code (906.5-906.9). A late effect E code may also be used, if
- When appropriate, both a sequelae with a late effect code, and a current burn code may
be assigned on the same record.
- Debridement of Wound, Infection, or Burn
- For coding purposes, excisional debridement, 86.22, is assigned only when the procedure
is performed by a physician.
- For coding purposes, nonexcisional debridement performed by the physician or
nonphysician health care professional is assigned to 86.28. Any "excisional"
type procedure performed by a nonphysician is assigned to 86.28.