ED Coding and Reimbursement Alert

Question: Which ICD-9 code should we report for a closed head injury""? There was no loss of consciousness. Because the physician specified the head injury as closed we were going to report 854.01 instead of 959.01.

Arkansas Subscriber  Answer: From a coding point of view 959.01 (Head injury unspecified) would be appropriate for a more minor injury involving a contusion of the head in which the patient has swelling or pain in the skin scalp or other non-bony soft tissues of the head. The exclusion note for this code refers to various other codes for more significant injuries that go beyond a basic bump on the head.

You should report codes from the 850-854 series including 854.01 (Intracranial injury of other and unspecified nature; without mention of open intracranial wound) for other specific and serious injuries involving the head such as concussions cerebral lacerations cerebral contusions and open wound with brain hemorrhage. This series represents very serious injuries resulting from high-energy impacts to the head. Specifically the 854 set includes cavernous sinus and intracranial injury.

So 959.01 fits with a contusion that happens to be on the head and the 850-854 series fits with serious and significant cranial and brain injuries.

Unfortunately the term ""closed head injury"" doesn't have a perfect ICD-9 match. ""Injury head"" in Volume II crosswalks to 959.01 but ""with loss of consciousness"" crosswalks to 850.5. So if the patient's head is banged and he doesn't have loss of consciousness or other significant brain or skull injuries 959.01 is appropriate.

From a clinical perspective when a physician states ""closed head injury"" as a diagnosis he probably means that the patient has an injury more extensive than a soft tissue contusion but not as extensive as a major intracranial injury. A concussion would represent the beginning of this spectrum.

The majority of the time in cases like these when physicians have a list of diagnoses to choose from they'll choose one that will crosswalk to 959.01. However armed with the inclusion criteria for the 854 series you might want to ask your physicians to define ""closed head injury"" more specifically since this is a description that varies among individual clinicians. For example if appropriate they could use the term ""concussion"" to indicate the more significant injury - which may help provide medical necessity for significant evaluations such as a computed tomography scan of the head. "