Orthopedic Coding Alert

Question: Our trauma surgeon treated a patient who had an injury caused by a motorcycle accident. One of the diagnoses on the chart is "neurogenic shock." How should we code this diagnosis?

New York Subscriber

Answer: Volume II of ICD-9 directs coders to look up the patient's specific spinal injury to determine the appropriate shock code. If appropriate, you may want to consider 958.4 (Traumatic shock) or 306.2 (Neurocirculatory asthenia).

Neurogenic shock usually follows an injury that affects the patient's spinal cord - frequently the area involved with sympathetic nerve centers. Neurogenic shock patients often have warm extremities, as opposed to patients suffering from other shock states, in which the extremities are cool, due to blood vessel constriction. Such patients have usually had a serious traumatic spinal injury.

The shock state (low blood pressure) is due to loss of sympathetic control (the nerves that allow for blood vessels to constrict). Be sure not to confuse neurogenic shock with hypovolemic shock, septic shock, cardiogenic shock, or anaphylactic shock.

Remember that you should list the patient's shock as a tertiary diagnosis code, because your orthopedic surgeon is probably treating a musculoskeletal condition, not the shock itself. Your primary diagnosis code should reflect the condition that your surgeon treated, such as a traumatic fracture.

 - You Be the Coder and Reader Questions were reviewed by Heidi Stout, CPC, CCS-P, coding and reimbursement manager at UMDNJ-RWJ University Orthopaedic Group in New Brunswick, N.J.