Radiology Coding Alert

Question: A patient came into our after-hours care facility presenting symptoms of pain in their rib area. After an initial E/M exam, the radiologist took X-rays and diagnosed the patient as having a bruised thorax without broken skin. The notes on the report also indicate there isn’t any swelling, redness, or skin discoloration.

I’m new to coding and unsure of how to code the diagnosis. Could you please walk me through which ICD-10-CM code I should use?

Vermont Subscriber

Answer: In this scenario, you’ll want to review the S20-S29 ICD-10-CM codes that cover injuries to the thorax. For this scenario, you’ll use S20.20XA (Contusion of thorax, unspecified, initial encounter), as the bruising occurred on the thorax, but the report you have does not specify if the injury is on the front wall or back wall of the thorax.

When coding injuries that fall under Chapter 19 of the ICD-10-CM manual, you’ll need a 7th character to accurately document the diagnosis. Adding the 7th character of A, B, D, G, K, or S to the end of the code will ensure proper reporting and identify if the episode of care is initial, subsequent, or sequela.

According to the ICD-10-CM Chapter 19 Guidelines, “Traumatic fractures are coded using the appropriate 7th character for initial encounter (A, B, C) for each encounter where the patient is receiving active treatment for the fracture.” For this patient, using the 7th character, A, specifies the visit as the initial encounter.