EmailACS 1907 Multiple injuries sequencing
Publication Date: December 2018
ICD 10 AM Edition: Tenth edition
Query Number: 3433
Seeking your interpretation of the following statement within ACS 1907 Multiple injuries.
'Sequencing of multiple injuries: In the case of multiple specified injuries, select as the principal diagnosis the condition which presents the most serious threat to life. If the most serious condition is not identified in the record, then clarification with the clinician should be sought.'
Many episodes contain multiple injuries/trauma, and the clinician does not state the most serious condition/threat to life in the episode notes. Many of these cases are in a SSU (short stay unit) for various abrasions, minor open wounds, fractures and contusions.
It's often difficult for the coder to ask which abrasion or contusion on the body had the most serious threat to life; similarly its difficult to ask whether the abrasion of the leg or the rib fractures was the most serious threat to life.
This doesn't seems like a documentation issue, as clinicians would seldom consider that a superficial injury of the knee is a threat to life over the one contusion the hand for example.
1. Does this rule pertain to all cases of multiple injuries regardless of injury type?
2. If the clinician lists an injury as the principal diagnosis on the discharge summary or final impression, without specification of a serious threat to life, can this be coded as the principal diagnosis?
3. In cases where there is no clear principal diagnosis or discharge summary, is it appropriate to send a query to the clinician asking for clarification of the principal diagnosis, without having to ask if there was a threat to life?
'Sequencing of multiple injuries: In the case of multiple specified injuries, select as the principal diagnosis the condition which presents the most serious threat to life. If the most serious condition is not identified in the record, then clarification with the clinician should be sought.'
Many episodes contain multiple injuries/trauma, and the clinician does not state the most serious condition/threat to life in the episode notes. Many of these cases are in a SSU (short stay unit) for various abrasions, minor open wounds, fractures and contusions.
It's often difficult for the coder to ask which abrasion or contusion on the body had the most serious threat to life; similarly its difficult to ask whether the abrasion of the leg or the rib fractures was the most serious threat to life.
This doesn't seems like a documentation issue, as clinicians would seldom consider that a superficial injury of the knee is a threat to life over the one contusion the hand for example.
1. Does this rule pertain to all cases of multiple injuries regardless of injury type?
2. If the clinician lists an injury as the principal diagnosis on the discharge summary or final impression, without specification of a serious threat to life, can this be coded as the principal diagnosis?
3. In cases where there is no clear principal diagnosis or discharge summary, is it appropriate to send a query to the clinician asking for clarification of the principal diagnosis, without having to ask if there was a threat to life?
Response
VICC agrees that many episodes contain multiple injuries/trauma without clear statement of which is the most serious condition or threat to life. In these situations, VICC advises to seek further clarification from the clinician or apply ACS 0001 Principal diagnosis and assign a code for the first mentioned injury.
In response to your specific questions, the quoted statement from ACS 1907 Multiple injuries does pertain to all cases of multiple injuries regardless of injury type. If the clinician lists an injury as the principal diagnosis on the discharge summary or final impression, without specification of a serious threat to life, it can be coded as the principal diagnosis. In cases where there is no clear principal diagnosis or discharge summary, it is appropriate to send a query to the clinician asking for clarification of the principal diagnosis, without having to ask if there was a threat to life.
You may wish to send a public submission to the ACCD asking for further direction on the most appropriate sequencing of multiple injuries when there is no clear threat to life.
In response to your specific questions, the quoted statement from ACS 1907 Multiple injuries does pertain to all cases of multiple injuries regardless of injury type. If the clinician lists an injury as the principal diagnosis on the discharge summary or final impression, without specification of a serious threat to life, it can be coded as the principal diagnosis. In cases where there is no clear principal diagnosis or discharge summary, it is appropriate to send a query to the clinician asking for clarification of the principal diagnosis, without having to ask if there was a threat to life.
You may wish to send a public submission to the ACCD asking for further direction on the most appropriate sequencing of multiple injuries when there is no clear threat to life.
