CCHIS has a new monthly newsletter that covers various coding topics and offer tips that promote accurate coding.

1. For the purposes of time and space the guidelines for
coding injuries are described as they relate to the “coding of an
injury to the internal carotid artery, intracranial portion in both
ICD-9 CM and ICD-10 CM. Only the initial encounter of the injury
will be discussed without mention of external cause codes or
surgical procedure codes.
The ICD-10 CM guidelines instruct the coder to assign
separate codes for each injury unless a combination code is
provided. The coder is cautioned against using T07 in the
inpatient setting and codes (S00-T14.9) are not to be used for
normal, healing surgical wounds or to capture any complications of
surgical wounds. As it relates to sequencing, the coder is
instructed to sequence first the most serious injury determined by
the physician and the focus of the treatment.
As it pertains to damage to nerves or blood vessels, the
coder is instructed to sequence the primary injury first when
minor injuries occur to the nerves, blood vessels and spinal cord.
If, however, the primary injury is the blood vessel or nerve, then
it should be sequenced first. These guidelines apply to both ICD-9
CM and ICD-10 CM.
CODING GUIDELINE
WHAT TO EXPECT
1 Coding Guideline
2 Coding Scenario
3 About CCHIS
4 Requests for Coding Topics
“Sequencing is
important!
Determine whether the
blood vessel/nerve is
the primary injury.”
JANUARY 2014
Volume 1 Issue 1
By Cynthia Brown, MBA, RHIT, CCS
www.cyntcodinghealthinformationservices.com
CCHIS, P.O. Box 3019, Decatur, GA 30031 404-992-8984
http://www.cyntcodinghealthinformationservices.com
Cynthia@cyntcodinghealthinformationservices.com [phone]
CODING YESTERDAY’S NOMENCLATURE TODAY®
Coding Traumatic Injury to Internal Carotid Artery
with Skull Fracture in both ICD-9 CM & ICD-10 CM
CODING NEWSLETTER FOR HEALTHCARE
CODING PROFESSIONALS

2. Page 2 Coding Yesterday’s Nomenclature Today
An unconscious 25-year old male patient involved in a
motorcycle racing accident reports to the ER of a Level I Trauma
Center. Upon further examination, the patient is found to have an
open temporal bone fracture of his skull along with a life-
threatening laceration to the internal carotid artery, intracranial
portion. The patient requires surgery to stop the epidural
hemorrhage and is admitted for further treatment of his injuries.
The physician has deemed the internal carotid artery injury to be
the primary injury. After surgery, the patient remained
unconscious and expires on the third day of admission.
ICD-9 CM Code: 801.75
ICD-10 CM Code: S02.19xB; S06.4x7A
In ICD-9 CM, the skull fracture, epidural hemorrhage, loss of
consciousness and resulting death are all captured in one code.
The coder should go to the alphabetical index under the term
fracture; temporal bone where they are further instructed to “see
fracture, skull base.” From there the coder can find the subterms
open, with epidural hemorrhage, 801.7. Upon checking the code in
the tabular index the coder will find that the code requires a fifth
digit The fifth digit subclassification 5 further captures the
patient’s conscious level and eventual death.
In ICD-10 CM, the same injuries are captured using two
codes. As stated above the coder should go to the alphabetical
index and locate the term fracture; then temporal bone where the
partial code S02.19 is found. Upon finding the code S02.19xB in the
tabular index of the ICD-10 codebook, the coder can see that there
is a seventh character requirement needed to complete the code.
The letter B is the correct seventh character for “initial encounter
for open fracture.” The coder is also reminded to add the
placeholder “x” before the seventh character to complete the
seven digit requirement for a complete code. The coder is also
instructed to “Code also any associated intracranial injury (S06.-).”
See injury, intracranial, epidural hemorrhage in the alphabetical
index. S06.4X is noted and after checking the tabular index, the
coder would find S06.4X7 would be appropriate to further capture
the patient’s continual unconscious state resulting in death. The
letter A is added to indicate “Initial Encounter” for episode of
care.
www.cyntcodinghealthinformationservices.com
Prolonged Unconsciousness
without return to pre-existing
conscious level resulting in death.
“Injury to the internal
carotid artery,
intracranial portion is
considered the primary
injury.”
Coding Scenario

3. Coding Yesterday’s Nomenclature Today
CyntCoding Health Information Services (CCHIS) specializes
in all aspects of coding and reimbursement. Nearly 30 years in the
Health Information field gives CCHIS the edge in knowing the ins &
outs of coding. CCHIS is dedicated to assisting healthcare providers
in optimizing their reimbursement through the reinforcement of
accurate and complete coding practices. The challenges of
inadequate staffing and changing coding rules and regulations will
be minimized by reliable coding and/or training. It is the goal of
CCHIS to reduce areas of concern in coding backlogs, insufficient
cash flow, inefficient coding practices, and potential non-
compliance risks.®
Accurate and complete coding is a must in today’s
economically challenged healthcare environment. The
uncertainties of the future for healthcare providers have raised the
awareness to achieve optimal reimbursement while ensuring
medical care is both cost-effective and medically necessary. CCHIS
is dedicated to helping providers achieve optimal reimbursement
through accurate and complete coding. ®
CCCHIS has an in-depth knowledge of coding guidelines;
NCCI edits; and CPT/HCPCS codes. Coding is performed in
compliance with CMS, Coding Clinic, and AMA guidelines. Coding
services can be performed onsite within industry standards,
productivity, and accuracy. ®
Cynthia Brown, MBA, RHIT, CCS is the company’s AHIMA
approved ICD-10 CM/PCS Trainer. Ms. Brown began her career a
Health Information Management professional in 1981. Since then
she has developed a passion for the HIM field that is second to
none. Excellence has always been the center of her motivation to
serve in areas of management, training, education, and coding.
Cynthia Brown has nearly 20 years of hands on coding
experience which gives her the knowledge and expertise needed to
identify and relate to the needs of your coding staff. She has
added instructional training to her extensive lists of capabilities
along with her years in coding and management.
Coding
Yesterday’s
Nomenclature
Today
Coding Health Information Services ®
AHIMA approved ICD-10 CM/PCS
Trainer
About CCHIS
“All Things Coding”®
“Accurate and
complete coding is a
must in today’s
economically
challenged healthcare
environment.”

4. Page 4 Coding Yesterday’s Nomenclature Today
CCHIS Professional Affiliates
AHIMA
GHIMA
AHIMA approved ICD-10 CM/PCS
Trainer
EDWOSB/WOSB
VOSB
SCORE Atlanta
CyntCoding Health Information
Services
P.O. BOX 3019
Decatur, GA 30031
Phone:
404-992-8984
E-Fax:
678-805-4919
E-mail:
cyntcoder1@aol.com or cyntcoder1@gmail.com
Requests for Coding Topics
E-mail your coding topics using the format below to:
cyntcoder@cyntcodinghealthinformationservices.com
CCHIS NEWSLETTER
TERMS AND CONDITIONS OF USE
All content provided in this “CCHIS Newsletter” is for informational purposes only. The owner
of this newsletter makes no representations as to the accuracy or completeness of any information
in this newsletter or found by following any link in this newsletter.
The owner of http://cyntcodinghealthinformationservices.com will not be liable for any errors or
omissions in information nor for the availability of this information. The owner will not be liable
for any losses, injuries, or damages from the display or use of this information. The terms and
conditions are subject to change at any time with or without notice.
CODING YESTERDAY’S NOMENCLATURE TODAY®
www.cyntcodinghealthinformationservices.com