ICD-10-CA Codes Partial Pick List

1 APPENDIX A Partial pick LIST OF INJURY AND SEQUELAE Codes ( ICD-10-CA ) Appendix A Page 1 What are ICD-10 and ICD-10-CA ? The International Statistical Classification of Diseases and Related Health Problems - Tenth Revision (ICD-10) is an international standard for reporting diseases, injuries, and causes of death developed by the World Health Organization (WHO). ICD-10-CA is an enhanced version of ICD-10 developed by CIHI and is the classification facilities use to record problems, diagnoses, symptoms and other conditions necessitating contact with health care providers. Where Can I Get a Complete List of ICD-10-CA Codes ? Visit the CIHI website for more information: Providers and software vendors can purchase products and publications related to coding directly from CIHI at , including: ICD-10-CA /CCI, 2010 (CD-ROM Single user).

2 O This product is similar to CD-ROM encyclopedias. The infobase automatically indexes every word and users may find information quickly using the software s search engine. code Title Tables 2015 (for use with ICD-10-CA /CCI). o The code title tables include all the valid diagnosis and intervention Codes and their descriptions. PDF versions of the 2015 ICD-10-CA and CCI will become available prior to June 1, 2015. Stakeholders will be notified as soon as these are available. ICD-10-CA and HCAI HCAI will only recognize valid ICD-10-CA Codes . In many cases it will be important for users of HCAI to learn how to use the HCAI search code utility to locate valid ICD-10-CA Codes .

3 Without valid ICD-10-CA Codes , HCAI users will be unable to submit forms to automobile insurers. ICD-10-CA code Structure ICD Base (mandatory) ICD Sub-Category (Optional) Position 1 Position 2-3 Position 4-6 Series Category Sub-Category Series (position 1) The Series code represents a broad category of disease, condition, injury, disorder, or symptom. Codes are grouped within a series based on: body system or anatomy ( respiratory, circulatory) cause or etiology ( injuries, infections) circumstances ( pregnancy) APPENDIX A Partial pick LIST OF INJURY AND SEQUELAE Codes ( ICD-10-CA ) Appendix A Page 2 Category (position 2-3) The Category code provides general details to describe the injury, disease, disorder, symptom or condition.

4 The meaning of each position within Category code varies from series to series. Sub-Category (position 4-6) The Sub-Category code provides specific details related to the injury, disease, disorder, symptom or condition. Generally, this level of detail is not required for automobile insurers. Conversion to 2015 Version of ICD-10-CA Periodically, HCAI will update the version of ICD-10-CA and users should ensure they are using current code sets, which are available at Most Significant Injury/Sequelae code The code (s) selected by health practitioners is intended to reflect 1. The problem, injury, diagnosis or condition directly related to the automobile accident; and 2.

5 The problem, injury, diagnosis or condition directly related to the automobile accident which is being addressed in the treatment plan or invoice. When there is more than one injury/problem/sequelae list the most significant code first. Physical Injury Physical injury Codes are primarily represented in Chapter XIX of the ICD-10-CA . The title of this chapter is Injury, poisoning and certain other consequences of external causes and the Codes represented here include S00 to S99. These Codes identify an injury involving one body part or region. Injuries Involving Multiple Body Regions Providers may wish to reference Chapter XIX of the ICD-10-CA when coding multiple injuries in a variety of body regions.

6 The sub-section is called Injuries involving multiple body regions and the Codes represented here include T00 to T07. Sequelae of Injuries, of Poisoning and of Certain Other Consequences Health providers may wish to refer to Chapter XIX of the ICD-10-CA to locate sequelae Codes . The sub-section to locate is called Sequelae of injuries, of poisoning and of certain other consequences and the Codes represented here include T90 to T98. Each sequelae grouping can be related back to the original physical injury that led to the sequelae. For example, if a claimant suffered an Injury to the Head as represented by the code for concussion ( ), the sequelae code for that injury can be found in the section called Sequelae of Injuries to the Head and the appropriate code for sequelae of concussion is The ICD-10-CA specifically defines this code as representative of sequelae associated with the concussion code ( ).

7 Prior Conditions or Old Injuries When coding injuries, problems and sequelae (Part 6 of the OCF 18, Part 5 of the OCF 23 and in the OCF 21), providers are asked to select a code that represents injuries and sequelae that are the direct result of the automobile accident . Pre-existing conditions are captured elsewhere in the OCF forms. The Canadian APPENDIX A Partial pick LIST OF INJURY AND SEQUELAE Codes ( ICD-10-CA ) Appendix A Page 3 Coding Standards for Version 20151 offers guidance on selecting the appropriate code . Current injuries are captured in Chapter XIX Injury, Poisoning and Certain Other Consequences of External Causes [S00 T98]) while old injuries may be captured in the body system chapters, such as Chapter XIII Diseases of the Musculoskeletal System and Connective Tissue [M00 M99]).

8 Example 1 (pg 329): Current Injury related to auto collision is tear of meniscus of knee. code = (Tear of meniscus, current). Nontraumatic (degenerative) tear of meniscus. code = (Other meniscus derangement including degenerate, detached or retained meniscus). CIHI asks users to exercise caution when coding conditions that are described as repetitive, degenerative and/or from overuse. These Codes are unrelated to a traumatic event and should not be classified as traumatic (pg 332) Greatest Use of Resources The most significant injury/sequelae code is the one code that identifies the problem, injury, diagnosis or condition directly related to the automobile accident which is or will be responsible for the greatest use of resources during the provision of care to the claimant in a given treatment plan or invoice.

9 In a case of multiple injuries, the most significant injury/sequelae is the injury requiring the most services. If no diagnosis was made, the main symptom, abnormal finding or problem should be selected as the most significant injury and reported first in the list of injuries/problems. 1 Canadian Coding Standards for Version 2015 ICD-10 and CCI. Canadian Institute for Health Information. 2015. APPENDIX A Partial pick LIST OF INJURY AND SEQUELAE Codes ( ICD-10-CA ) Appendix A Page 4 Appendix A Partial List of ICD-10-CA Codes Chapter XIX ICD-10-CA ICD-10 code Description Strains & Sprains S034 Sprain and strain of jaw S091 Injury of muscle and tendon of head S1340 Whiplash associated disorder [WAD1] with complaint of neck pain, stiffness or tenderness only S1341 Whiplash associated disorder [WAD2]

10 With complaint of neck pain with musculoskeletal signs S16 Injury of muscle and tendon at neck level S233 Sprain and strain of thoracic spine S234 Sprain and strain of ribs and sternum S290 Injury of muscle and tendon at thorax level S335 Sprain and strain of lumbar spine S336 Sprain and strain of sacroiliac joint S390 Injury of muscle and tendon of abdomen, lower back and pelvis S434 Sprain and strain of shoulder joint S435 Sprain and strain of acromioclavicular joint S436 Sprain and strain of sternoclavicular joint S4378 Sprain and strain of other parts of shoulder girdle S46 Injury of tendon at shoulder and upper arm level S460 Injury of tendon of the rotator cuff of shoulder S461 Injury of muscle and tendon of long head of biceps S462 Injury of muscle and tendon of other parts of biceps S463 Injury of muscle and tendon of triceps S534 Sprain and strain of elbow S56 Injury of muscle and tendon at forearm level S560 Injury of flexor muscle and tendon on thumb at forearm level S561 Injury of long flexor muscle and