General Surgery Coding Alert

Laceration, puncture, and more expand codes.

Coding wound closure requires identifying wound characteristics, and that will become a lot more specific when you change from ICD-9 to ICD-10.

Remember: CMS has finalized the ICD-10 implementation date for Oct. 1, 2014, delaying the action one year from the original deadline.

Distinguish Wound Type for ICD-10 Detail

Although ICD-9 and ICD-10 contain a host of codes for reporting wounds based on body site, we'll focus on wounds of the back to illustrate the level of detail you can expect with the code-set change.

ICD-9 provides just one code for uncomplicated open back wound that doesn't penetrate the thoracic cavity -- 876.0 (Open wound of back without mention of complication).

ICD-10 greatly expands your code choices by specifying the wound type, as follows:

• S21.20 -- Unspecified open wound of back wall of thorax without penetration into thoracic cavity
• S21.21 -- Laceration without foreign body of back wall of thorax without penetration into thoracic cavity
• S21.22 -- Laceration with foreign body of back wall of thorax without penetration into thoracic cavity
• S21.23 -- Puncture wound without foreign body of back wall of thorax without penetration into thoracic cavity
• S21.24 -- Puncture wound with foreign body of back wall of thorax without penetration into thoracic cavity
• S21.25 -- Open bite of back wall of thorax without penetration into thoracic cavity.

Add Location Specificity with Extra Digit

Wound type isn't the only increased specificity you'll have with ICD-10. The codes will also allow you to locate the wound more specifically.

Sixth digit: Each of the preceding codes requires an additional digit that specifies the following information as a descriptor of the back wall of thorax:

• 1 -- right
• 2 - left
• 9 - unspecified.

Example: The definition for S21.231 is "Puncture wound without foreign body of right back wall of thorax without penetration into thoracic cavity."

Caution: If the open wound involves the lower back and pelvis, you'll need to look to a different code family in ICD-10: S31.0 (Open wound of lower back and pelvis). Extended codes add similar detail about the wound type, like puncture, laceration, etc.