Some of the more common causes of blood vessel injury include gunshot wounds, stab wounds, blunt trauma (including blunt trauma with fracture or dislocation) and iatrogenic injuries. With more procedures being performed using intravascular techniques of late, the number of iatrogenic injuries to blood vessels has increased. Understanding the differences between ICD-9-CM and ICD-10-CM coding for blood vessel injuries occurring as a complication of a surgical procedure will help with correct code assignment when ICD-10-CM is implemented.
In ICD-9-CM, codes for iatrogenic injuries of blood vessels are found in Chapter 17, Injury and Poisoning. An injury to a blood vessel complicating a surgical procedure is reported with one of three nonspecific codes, as follows:
998.11 Hemorrhage complicating a procedure;
998.12 Hematoma complicating a procedure; and
998.2 Accidental puncture or laceration during a procedure.
It should be noted that no distinction is made in ICD-9-CM for intra-operative or postoperative hemorrhage or hematoma.
In ICD-10-CM, codes for intra-operative and post-procedural blood vessel injuries are found in Chapter 9, Diseases of the Circulatory System. ICD-10-CM classifies body system-specific, intra-operative and post-procedural complications within each body system chapter, rather than in Chapter 19 (Injury, Poisoning and Certain Other Consequences of External Causes).
While ICD-10 codes for intra-operative and post-procedural complications affecting blood vessels are not specific to the site of the injury, they are specific to the body system affected, which in the case of blood vessel injuries is the circulatory system. Codes are also specific to the type of injury – hemorrhage and hematoma or puncture and laceration. Hemorrhage and hematoma codes are specific to whether the complication occurs during a surgical procedure or postoperatively, and these codes are also specific to some types of procedures (including cardiac catheterization, cardiac bypass, other circulatory system procedure or other procedure). Puncture and laceration codes are specific to whether the blood vessel injury occurred during a circulatory system procedure or during a procedure being performed on another body system.
For intra-operative hemorrhage and hematoma of a blood vessel or other circulatory system organs or structures, the following codes apply:
I97.410 – Use when the hemorrhage or hematoma complicates a cardiac catheterization procedure.
I97.411 – Use when the hemorrhage or hematoma complicates a cardiac bypass procedure.
I97.418 – Use when the hemorrhage or hematoma complicates another circulatory system procedure.
I97.42 – Use when the hemorrhage or hematoma complicates a procedure on a body system other than the circulatory system.
For post-procedural hemorrhage and hematoma of a blood vessel or other circulatory system organs or structures, the following codes apply:
I97.610 – Use when the hemorrhage or hematoma complicates a cardiac catheterization procedure.
I97.611 – Use when the hemorrhage or hematoma complicates a cardiac bypass procedure.
I97.618 – Use when the hemorrhage or hematoma complicates another circulatory system procedure.
I97.62 – Use when the hemorrhage or hematoma complicates a procedure on a body system other than the circulatory system.
For accidental puncture and laceration of a blood vessel or other circulatory system organ or structure, the following codes apply:
I97.51 – Use when the accidental puncture or laceration occurs during a circulatory system procedure.
I97.52 – Use when the accidental puncture or laceration occurs during a procedure on another body system.
About the Author
Lauri Gray, RHIT, CPC, has worked in the health information management field for 30 years. She began her career as a health records supervisor in a multi-specialty clinic. Following that she worked in the managed care industry as a contracting and coding specialist for a major HMO. Most recently she has worked as a clinical technical editor of coding and reimbursement print and electronic products. She has also taught medical coding at the College of Eastern Utah. Areas of expertise include: ICD-10-CM, ICD-10-PCS, ICD-9-CM diagnosis and procedure coding, physician coding and reimbursement, claims adjudication processes, third-party reimbursement, RBRVS and fee schedule development. She is a member of the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA).
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