Internal Medicine Coding Alert

Question: What is the ICD-9 code for "easy bruising"?

Answer: Easy bruising is a symptom of another condition rather than a standalone diagnosis. Therefore, the ICD-9 code depends on whether or not the internist identified a cause. If a cause is identified, then code for the specific disease. If, however, no cause is pinpointed, then code for the symptoms.

For easy bruising with no identifiable cause, report 782.7 (Spontaneous ecchymoses). An individual may be suffering from other diseases that predispose him to develop bruises even with minimal trauma (such as a light rap on the hands), which otherwise will not happen to normal people, hence resulting in "easy bruising." Diseases that could result in this include platelet or coagulation disorders (thrombocytopenias), bone marrow disorders, hemophilias, liver diseases, and Marfan's syndrome. Aging and medications (for example, aspirin, prednisone, and other nonsteroidal anti-inflammatory drugs) can also cause easy bruising. For patients suffering from these conditions, bruises seem to spontaneously appear without any identifiable reason.

An ecchymosis is a bruise larger than 1 centimeter. A bruise less than 1 centimeter but not less than 3 millimeters is called a purpura. A bruise less than 3 millimeters is called a petechiae. Code 782.7 applies also to petechia but not purpura, which has several other codes (287.0-287.9) depending on the etiology.

Bruises resulting from trauma can occur due to a variety of reasons, including falls, accidents, and post-surgeries. In general, use codes 920-924 (Contusion with Intact Skin Surface) for bruises secondary to trauma. For example, for a soccer player who was seen by an intern for bruises in the heel, use 924.20 (Contusion of lower limb and of other and unspecified sites; ankle and foot, excluding toe[s]; foot [which includes the heel]). Note that, per ICD-9, these codes exclude contusions that are incidental to specific categories of injuries, such as crushing injury (925- 929.9), dislocation (830.0-839.9), fracture (800.0-829.1),internal injury (860.0-869.1), intracranial injury (850.0-854.1), nerve injury (950.0-957.9), and open wound (870.0-897.7).