Home Health ICD-9/ICD-10 Alert

Big changes include seventh characters and increased specificity.

Coding for open wounds in ICD-9-CM can be confusing. But your options for coding them in ICD-10-CM are greatly expanded. Take a closer look at what ICD-10-CM has to offer for these injuries.

Describe Cut’s Nature

Although ICD-9-CM wound codes primarily use the terms “open wound” or “laceration,” you’ll need to have more information if you want to take advantage of ICD-10-CM’s greater specificity. For instance, the ICD-10-CM codes often distinguish between laceration, puncture wound, and open bite using different codes.

On the other hand, ICD-9-CM provides some distinctions that you won’t find in ICD-10-CM, such as specifying “with complications.”

In ICD-9-CM there are combination codes for open wound with and without tendon involvement, says Ann Zeisset, RHIT, CCS, CCS-P, AHIMA-Approved ICD-10-CM/PCS Trainer with Ann Zeisset Consulting in Trenton, Ill. ICD-9-CM also uses a definition of complicated which includes delayed healing, delayed treatment, foreign body, and infection.

But you can still show that there was infection or a foreign body in ICD-10-CM, Zeisset says. You’ll find specific wound codes for with and without foreign body. And you can add an ICD-10-CM infection code or laceration of tendon code when appropriate. Plus, in ICD-9-CM, the wound code doesn’t specify what the complication was, while in ICD-10-CM, you’ll be able to specify this with an add-on code.

Isolate Location

Although both ICD-9-CM and ICD-10-CM identify the wound’s anatomic site, such as knee or neck, ICD-10-CM provides more specificity by including “right,” “left,” or “unspecified.”

Example: Let’s see how ICD-9-CM and ICD-10-CM stack up for open wounds of the knee and lower leg.

ICD-9-CM code choices:

• 891.0 — Open wound of knee, leg [except thigh], and ankle; without mention of complication
• 891.1 — Open wound of knee, leg [except thigh], and ankle; complicated
• 891.2 — Open wound of knee, leg [except thigh], and ankle; with tendon involvement

ICD-10-CM code choices:

• S81.00-- — Unspecified open wound of knee
• S81.01-- — Laceration without foreign body of knee
• S81.02-- — Laceration with foreign body of knee
• S81.03-- — Puncture wound without foreign body of knee
• S81.04-- — Puncture wound with foreign body of knee
• S81.05-- — Open bite of knee
• S81.80-- — Unspecified open wound of lower leg
• S81.81-- — Laceration without foreign body of lower leg
• S81.82-- — Laceration with foreign body of lower leg
• S81.83-- —Puncture wound without foreign body of lower leg
• S81.84-- — Puncture wound with foreign body of lower leg
• S81.85-- — Open bite of lower leg

Notice that each of these codes requires a sixth and seventh character, as follows:

Sixth character:

1 = right

2 = left

9 = unspecified.

Seventh character:

• A =initial encounter
• D =subsequent encounter
• S =sequela.

Remember, when choosing the seventh character of an ICD-10-CM code in home health, you’ll most often list “D” or “S.” Seventh character “A” is used for patients receiving active treatment such as from the emergency department or on the first visit to a physician.

Seventh character “D” is used for patients receiving routine care during the healing or recovery phase. And, seventh character “S” indicates complications or other conditions that occur as the result of the condition. This is equivalent to “late effect” in ICD-9-CM and is called sequela in ICD-10-CM.

Coding example: Your patient was hit by a metal swing and suffered a deep laceration to her right lower leg, which was surgically closed. Your agency will be providing wound care. You would report the following codes in ICD-9-CM:

• V58.43 (Aftercare following surgery for injury and trauma);
• 891.0 (Open wound of knee, leg [except thigh], and ankle, without mention of complication); and
• V58.31 (Encounter for change or removal of surgical wound dressing).

Under ICD-10-CM, for this patient, you would report:

• S81.811D (Laceration without foreign body, right lower leg, subsequent encounter) and
• Z48.01 (Encounter for change or removal of surgical wound dressing).

Bottom line: ICD-10-CM provides 36 seven-character codes to replace ICD-9-CM’s three four-digit codes describing open wounds to the lower leg and knee.