You’ll need to know your seventh characters.
ICD-10-CM gives you more options and greater specificity for most conditions, and open wounds are no exception. Take a closer look at what you’ll need to know to complete the OASIS diagnosis code items (currently M1020, M1022, and M1024), and welcome the increased level of detail you’ll be able to report for these injuries.
Describe Cut’s Nature
Although ICD-9-CM 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 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:
ICD-10-CM code choices:
Notice that each of these codes requires a sixth and seventh character, as follows:
Sixth character:
1 = right
2 = left
9 = unspecified.
Seventh character:
Remember, when choosing the seventh character in home health, you’ll most often list “D” or “S.” Seventh character “A” is only appropriate for patients receiving active treatment such as from the emergency department or on the first visit to a physician.
Use seventh character “D” 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:
Under ICD-10-CM, for this patient, you would report:
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.