Dislocations: ICD-10-CM Coding
Dislocations are joint injuries that force the ends of your bones out of position. The cause is often a fall or a blow (for instance, sustained while playing a contact sport). Joints that can dislocate include:
For example, nursemaid’s elbow is a partial dislocation common in toddlers. The main symptom is refusal to use the arm. Nursemaid’s elbow can be easily treated in a doctor’s office.
A dislocated joint may be accompanied by numbness or tingling at the joint or beyond it. Additional signs and symptoms may include
- Intense pain, especially if you try to use the joint or bear weight on it
- Limited movement
- Swelling or bruising
- The joint area may be visibly out of place, discolored, or misshapen
Complications of a joint dislocation may include:
- Tearing of the muscles, ligaments and tendons that reinforce the injured joint
- Nerve or blood vessel damage in or around your joint
- Susceptibility to re-injury if you have a severe dislocation or repeated dislocations
- Development of arthritis in the affected joint as you age
If ligaments or tendons that support the injured joint have been stretched or torn, or if nerves or blood vessels surrounding the joint have been damaged, surgery may be required to repair the tissues.
Documentation and Code Selection
Good clinical documentation should indicate the location of the dislocation including laterality (right or left) and the extent of dlsocation:
The extent of the dislocation may be defined using several methods:
- Subluxation – Partial of incomplete dislocation of joint
- Dislocation – Complete dislocation of the joint, also known as luxation of the joint
- Percentage – Dislocations of certain joints are further classified by the extent based upon percentage of the dislocation.
Dislocations may further be defined by positioning:
Anterior – The end of the bone is displaced to the anterior, medial, and slightly inferior to its normal anatomic position.
Posterior – The end of the bone is displaced posterior to the joint and its normal anatomic position.
Inferior – The end of the humerus is forced against the acromion causing the arm to lock in an upward and backward position.
Laterally – The end of the bone is displaced outwardly (laterally) to the joint and its normal anatomic position.
S03 Dislocation and sprain of joints and ligaments of head
S13 Dislocation and sprain of joints and ligaments at neck level
S23 Dislocation and sprain of joints and ligaments of thorax
S33 Dislocation and sprain of joints and ligaments of lumbar spine and pelvis
S43 Dislocation and sprain of joints and ligaments of shoulder girdle
S53 Dislocation and sprain of joints and ligaments of elbow
S63 Dislocation and sprain of joints and ligaments at wrist and hand level
S73 Dislocation and sprain of joints and ligaments of hip
S83 Dislocation and sprain of joints and ligaments of knee
S93 Dislocation and sprain of joints and ligaments at ankle, foot, and toe level
The encounter should also be documented such as initial encounter, subsequent encounter, or sequela.
7th Character Extenders
ICD-10-CM includes (and requires) seventh characters extensions for most categories in chapter 19. With the exception of fractures, most categories in chapter 19 have three extensions:
A for initial encounters: This means the patient is receiving active medical treatment. Examples of active treatment are surgical treatment, emergency department encounter, and evaluation and treatment by a new physician.
D for subsequent encounter: This means the patient is receiving routine care after completed active treatment. Examples are follow-up care, cast change or removal, removal of external or internal fixation device, and medications adjustment.
S to indicate a sequela of the condition. The sequela are the residual effecst (condition produced) after the acute phase of a illness or injury has terminated
Remember, in ICD-10-CM, the seventh character must always be the seventh character in the data field. A placeholder X must be used to fill any empty characters.
Separately Report Open Wound
In ICD-10-CM open or closed is no longer a combination code when coding for dislocations. Instead, ICD-10-CM includes an instructional note at the beginning of each category of dislocation (S03, S13. S23, S33, S43, S53, S63, S73, S83, S93) that informs the user to code separately any associated open wound.