ED Coding and Reimbursement Alert

Laterality, location count when seeking these ICD-10 codes.

Selecting the most accurate codes can be challenging when patients present with bruises, because these contusions can sometimes be symptoms of a more serious condition. In addition, you’ve got to account for location, laterality, and other factors when selecting the right codes in this category.

Test your contusion coding knowledge with a quick quiz that will allow you to assess your contusion knowledge.

Use This Contusion Definition

Question 1: What is a contusion?

Answer 1: A bruise, or contusion, is caused when the blood vessels are damaged or broken as the result of a blow to the skin such as to part of the foot, ankle, or toes (such as an accidental hammer hit). The raised area of a bump or bruise results from blood leaking from these injured blood vessels into the tissues as well as from the body’s response to the injury. Contusions cause swelling and pain and limit joint range of motion near the injury. In severe cases, swelling and bleeding beneath the skin may cause shock. If tissue damage is extensive, the patient may also have a broken bone, dislocated joint, sprain, torn muscle, or other injuries.

Be Wary of ‘Easy Bruising’

Question 2: Sometimes patients will present for a different condition, but the ED physician will notice contusions, which the patient may brush off by saying they “bruise easily.” Is there any specific diagnosis code for easy bruising?

Answer 2: “Easy bruising” is a symptom, not a diagnosis. You would report the diagnosis code depending upon whether the provider identified a cause. If the cause is identified, you should code for the specific disease. However, if the clinician does not document the cause, you should code for the symptoms.

If the clinician documents “easy bruising” with no identifiable cause, then you should report R23.3 (Spontaneous ecchymoses). For example, a patient may suffer from a disease such as a bone marrow disorder that predisposes her to develop bruises, even with a light rap on her feet, which may not bother other patients. This rap could result in “easy bruising” for that particular patient.

Coding tip: An ecchymosis is defined as a bruise that is larger than 1 cm. A bruise that is less than 1 cm, but not less than 3 mm, is called a purpura. A bruise less than 3 mm is called a petechiae. Although R23.3 also applies to petechia, you should not report this code for purpura.

Report Trauma-Induced Bruises This Way

Question 3: If the patient has a bruise caused by a trauma, how would we report that?

Answer 3: Bruises resulting from trauma can occur due to a variety of reasons, including falls, accidents, and post-surgeries. In general, use codes from category
S90- (Superficial injury of ankle, foot and toes) for bruises secondary to trauma.

Note that, as per ICD-10, these codes are for the initial visit only and you should appropriate corresponding codes according to subsequent visits.

Narrow Down Cause With These Questions

Question 4: If the patient presents with a contusion, what are some questions we can ask to help us choose the correct diagnosis code?

Answer 4: If the patient presents with a contusion, you need to answer the following questions to choose the correct ICD-10 code:

• What is the exact site of contusion (for example, ankle, toe, or foot)?
• What side of the body is the contusion located?
• Is this the first visit or subsequent?

“As well as identifying whether it is an initial or subsequent visit and locating the correct side of the body, in the clinical notes, I would also include the measurement of the contusion as well as a description of the extent of the contusion,” says Arnold Beresh, DPM, CPC, CSFAC, a practitioner in West Bloomfield, Michigan.