ICD-10 Sprains, Strains, and Automobile Accidents.

This installment in Family Practice Management’s series on ICD-10 documentation and coding will focus on the minor trauma family physicians tend to see in an office setting – knee injuries, wrist fractures, bruised fingers, etc. More complicated injuries seen in some rural practice settings, urgent care facilities, or emergency departments are beyond the scope of this article. Injuries are typically coded from Chapter 19 of the ICD-10 manual, “Injury, Poisoning, and Certain Other Consequences of External Causes” (codes S00-T88). In addition, Chapter 13, “Diseases of the Musculoskeletal System and Connective Tissue” (codes M00-M99), which deals with nontraumatic diseases, includes some of the consequences of the Chapter 19 injuries that a primary care physician would see. (See “Common family medicine codes from Chapter 13,” page 13.) Almost every body area includes multiple codes for minor injuries. For example, there are 12 codes for superficial abrasion of the finger – one for each of the 10 digits, one for unspecified thumb, and one for unspecified finger. Be careful, though: If you submit a claim using one of the unspecified codes, it indicates a lack of documentation. There are no codes for multiple fingers, so you must separately code each finger that suffered an abrasion. Although I just said there are 12 codes for a superficial finger abrasion, technically there are 36 codes because each code needs a seventh character: “A” for initial encounter, “D” for subsequent encounter, or “S” for sequelae. This seems fairly straightforward, except the terms “initial” and “subsequent” reference the phase of treatment from the patient’s perspective, not yours: • “A,” initial encounter, means the patient is receiving active treatment for the condition, regardless of whether the service is rendered by the initial physician or a new one. If you see a patient in the office for the first time after a finger fracture is treated in the emergency department and you do not actively change the treatment, the encounter would not be considered initial. If you see a