Radiology Coding Alert

Understand how to report loss of consciousness.

The ICD-10-CM code set is out for 2023, and with 1,468 new codes, there is a lot of information to soak up before the codes take effect on Oct. 1, 2022. Radiology Coding Alert takes a dive into the new concussion and primary blast injury of the brain codes — as well as a new contrast-related code that radiology coders should take note of.

Check out several of the new codes added to the 2023 ICD-10-CM code set.

Expand Your Concussion Coding Knowledge

In the S06.0X- (Concussion) code subcategory, you’ll find the new code S06.0XA- (Concussion with loss of consciousness status unknown), which also features “Concussion NOS” as an additional synonym.

Several codes in the S06.- (Intracranial injury) code category, including S06.0XA-, feature descriptors that call out a specific amount of time in which the patient lost consciousness. But how do you report instances where the patient lost consciousness for less than 30 minutes or the provider is unsure if the patient lost consciousness? “The current default states ‘with loss of consciousness of unspecified duration,’ which implies a loss of consciousness, but also applies to patients who have not experienced one. The new codes will allow for better tracking of patients who lose (or don’t lose) consciousness after an injury, and this is important because loss of consciousness is tied to outcomes, including sequelae,” says Sheri Poe Bernard, CCS-P, CRC, CDEO, CPC, managing risk adjustment consultant of Granite GRC Consulting in Lancaster, Pennsylvania.

Parent code S06.- instructs you to use the following 7th characters with each code from the category, with exceptions (read further to learn about new codes that don’t follow the 7th character rule):

• A: Initial encounter
• D: Subsequent encounter
• S: Sequela

The new seven-character codes in the S06.0XA-subcategory are as follows:

• S06.0XAA (Concussion with loss of consciousness status unknown, initial encounter)
• S06.0XAD (Concussion with loss of consciousness status unknown, subsequent encounter)
• S06.0XAS (Concussion with loss of consciousness status unknown, sequela)

Since S06.0XA- code receives “Concussion NOS” as an additional synonym, the synonym is deleted in 2023 from S06.0X9 (Concussion with loss of consciousness of unspecified duration). At the same time, S06.0X1- (Concussion with loss of consciousness of 30 minutes or less) gains the synonym of “Concussion with brief loss of consciousness.”

Make a Plan for Primary Blast Injury of the Brain Codes

New to the 2023 ICD-10-CM code set are 41 codes related to primary blast injuries of the brain. The new seven-character codes allow you to assign codes for diagnoses where the patient didn’t lose consciousness, where the patient did lose consciousness for a specific duration, if the patient passed away prior to regaining consciousness, and other unspecified conditions.

What is a primary blast injury of the brain? “A primary blast injury is an injury caused by a blast wave associated with explosives. These codes are similar to codes for primary blast injuries of other anatomical locations,” Poe Bernard says.

You’ll assign S06.8A0- (Primary blast injury of brain, not elsewhere classified without loss of consciousness) with the corresponding 7th character for a patient diagnosed with a primary blast injury of the brain, not elsewhere classified (NEC), where they didn’t lose consciousness.

If the patient experienced a primary blast injury to the brain and lost consciousness for a certain amount of time, you’ll assign a code with the corresponding 7th character from the following choices:

• S06.8A1- (Primary blast injury of brain, not elsewhere classified with loss of consciousness of 30 minutes or less)
• S06.8A2- (… with loss of consciousness of 31 minutes to 59 minutes)
• S06.8A3- (… with loss of consciousness of 1 hour to 5 hours 59 minutes)
• S06.8A4- (… with loss of consciousness of 6 hours to 24 hours)
• S06.8A5- (… with loss of consciousness greater than 24 hours with return to pre-existing conscious level)
• S06.8A6- (… with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving)

If you have documentation stating the patient experienced a primary blast injury of the brain and lost consciousness, but the record doesn’t specify if the patient has regained consciousness or how long they were unconscious, then you can assign codes with appropriate 7th characters from the following:

• S06.8AA- (… with loss of consciousness status unknown)
• S06.8A9- (… with loss of consciousness of unspecified duration)

However, if the patient experienced a primary blast injury of the brain, lost consciousness, and passed away before regaining consciousness, you’ll assign a code from the following:

• S06.8A7- (… with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness)
• S06.8A8- (… with loss of consciousness of any duration with death due to other cause prior to regaining consciousness)

Exception to the rule: In the S06.- category, the two codes listed above are examples of exceptions to the 7th character required rule. Parent code S06.- features a note stating that 7th characters D and S don’t apply to codes where the 6th character is a 7 or 8. “Since 6th characters 7 and 8 relate to the patient’s death, using a 7th character to indicate the type of encounter or sequela is incorrect based on the note at the beginning of the S06.- section,” says Kristen Taylor, CPC, CHC, CHIAP, associate partner of Pinnacle Enterprise Risk Consulting Services.

Report the Side Effects of Contrast-Based Imaging Procedures

New to the 2023 ICD-10-CM code set is N14.11 (Contrast-induced nephropathy), which is designated to report patients who experience nephropathy as a complication of diagnostic and therapeutic procedures involving contrast medium. Nephropathy is an impairment of the patient’s kidney function.

“About 10 percent of patients undergoing radiographic procedures of the kidney who receive contrast experience contrast-induced nephropathy,” Poe Bernard says. This condition may lead to chronic kidney disease (CKD) or kidney failure, and a majority of patients who experience this complication have an underlying endocrine, heart, or kidney problem.

Code N14.11 also features the synonym “Contrast medium, radiography nephropathy.” Plus, the code receives an Excludes2 note that features N17.- (Acute kidney failure).

“Code N14.11 was created to specifically capture this iatrogenic disorder for the first time,” Poe Bernard adds. An iatrogenic disorder occurs when the harmful effects of a diagnostic or therapeutic regimen causes damage to the patient.