Health data standards and systems

1. How should 'rectus sheath haematoma secondary to anticoagulation' be coded please?
There is an index entry: Haematoma, nontraumatic due to circulating anticoagulants D68.3
So is it D68.3 only (plus ext cause codes)?
Or
Index: Haematoma, muscle - see Contusion, by site
Contusion, abdominal (muscle)(wall) S30.1
So is it S30.1, D68.3 etc?
Or
Index: Haematoma, internal organ NEC - see Injury, by site
Injury, muscle, abdominal S39.0
So is it S39.0, D68.3, etc?

Each of these give a different DRG and this is not an uncommon diagnosis so would like to have a reference as to the correct coding.

2. Why does the index entry at Haematoma, abdominal (muscle)(wall) S30.1 have a non-essential modifier for muscle, when there is a specific code for abdominal muscle injury (S39.0)?

VICC advises that for the case cited the correct codes to assign are S30.1 Contusion of abdominal wall following the Index entry noted in the query and D68.3 Haemorrhagic disorder due to circulating anticoagulants.

Both codes are required to describe the site of the haematoma and the haemorrhagic component, which is in accordance with ACS 0303 Abnormal coagulation profile due to anticoagulants and ACS 1902 Adverse effects.

The sequencing of the codes is in accordance with example 2 of ACS 0303 Abnormal coagulation profile due to anticoagulants.

As the rectus sheath is not an internal organ, it is incorrect to follow Index entry Haematoma/internal organ NEC - see Injury, by site.