ED Coding and Reimbursement Alert

Emergency Department Coding:

Consider Injury Type When Choosing These 2nd Characters

Question: When reporting a code from Chapter 19 of ICD-10-CM code book: Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88), what do the 3rd characters represent?

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Answer: We mentioned 3rd characters briefly last month in the article “Take Traumatic Fracture Diagnoses to the 7th Character.” Since we were only dealing with fractures, we didn’t delve into the specifics of 3rd-character coding for Chapter 19 codes when the injury isn’t a fracture; however, the 3rd character of a Chapter 19 code can indicate other types of injuries as well.

Emergency sign on a hospital hallway wall with medical staff and a stretcher in the background

There is a taxonomy for the 3rd characters in a Chapter 19 code. That’s according to Leigh Poland, RHIA, CCS, CDIP, CIC, AHIMA Approved ICD-10-CM/PCS Trainer, who explained the classification system during her HEALTHCON 2026 presentation “Trauma Coding Mastery: Navigating ICD-10-CM/PCS for Complex Injury Encounters.”

As we discussed last month, the 2nd character of a Chapter 19 diagnosis identifies the body part injured. For example, code injuries to the abdomen, lower back, lumbar spine, pelvis, or genitalia with 2nd character “3.”

The 3rd character of a fracture diagnosis offers details on the injury type. According to Poland, these are the 3rd-character options for Chapter 19 codes:

  • Superficial injury: 0
  • Open wound: 1
  • Fracture: 2
  • Dislocation, sprained joints/ligaments: 3
  • Injuries to nerves and spinal cord: 4
  • Injury to blood vessels: 5
  • Injury to muscle, fascia, tendons, organs: 6
  • Crushing injury or organ injury: 7
  • Avulsion or traumatic amputation: 8
  • Other and unspecified: 9.

Chris Boucher, MS, CPC, Senior Development Editor, AAPC