277 Concerned parents often seek reassurance from pediatricians when their children experience the bumps and bruises of childhood. Finding diagnoses for these injuries will change a bit with the transition to International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) classifies injuries first by type of injury and then body part for example, all superficial injuries such as abrasions, blisters, and bug bites are found in categories 910–919 with subcategories for body areas. In ICD-10-CM, injuries are classified according to body part and then type of injury for example, injuries to the head are reported with codes in categories S00–S09 with subcategories for types of injuries. These categories begin with codes for superficial injuries. Types of superficial injuries included here are abrasions, nonthermal blisters, contusions, external constriction, superficial foreign body, insect bites, and other superficial bites. ICD-10-CM guidelines provide a few instructions that are helpful when selecting a code. When coding injuries, assign separate codes for each injury unless a combination code is provided, in which case the combination code is assigned. The code for the most serious injury, as determined by the provider and the focus of treatment, is sequenced first. Superficial injuries such as abrasions or contusions are not coded when associated with more severe injuries of the same site. Aftercare Z codes should not be used for aftercare for conditions such as injuries or poisonings, where seventh characters are provided to identify subsequent care. For example, for aftercare of an injury, assign the acute injury code with the seventh character D (subsequent encounter). The seventh character S identifies the injury responsible for the sequela. The specific type of sequela (eg, scar) is sequenced first, followed by the injury code with seventh character S. Use an additional code from category Z18 to identify any retained foreign body when applicable. External cause-of-morbidity codes from Chapter 20 should be assigned in addition to injury codes to identify the cause, intent, place, activity, and status of the patient at the time of the accident. Appendix B-23 Bites, Bruises, and Other Superficial Injuries (continued on page 278)
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