Uncal Herniation in Traumatic Brain Injury

jillian.bisbejillian.bisbe
in Clinical & Coding

Patient presents with traumatic SDH & SAH- non surgical/non survivable. F/u CT head shows uncal herniation and support is withdrawn and patient expires.

Can I code compression of the brain with the traumatic brain injury? I've been told no because its considered "inherent". That makes ZERO sense. Herniation is not inherent to a traumatic head injury. I cannot find any coding clinic guidance nor is there excludes 1 note. Thanks!


Comments

  • annnd2009@gmail.comannnd2009@gmail.com
    Hi Jillian,

    I have had to run this through the encoder, and usually ask my expert Neuro friend if it's been too long since I have had to code one of these patients. 
     I do not have an  encoder, or book in front of me

    The main thing is to make sure you carefully enter the traumatic portion to get to the right code.

    I think traumatic compression codes to intracranial injury s06.
    And other non-traumatic  codes to G93.5- which contains excludes 1- "Type 1 Excludes 
    • diffuse traumatic compression of brain (S06.2-)
    • focal traumatic compression of brain (S06.3-)"
    Ann


    internet references:

    Intracranial injury S06- >

    -Code Also 
    • any associated:
    • open wound of head (S01.-)
    • skull fracture (S02.-)
    Type 1 Excludes 
    Includes 
    • traumatic brain injury
    Clinical Information 
    • Brain injury resulting from an accident, surgery, or other trauma.
    • Traumatic brain injury happens when a bump, blow, jolt, or other head injury causes damage to the brain. Every year, millions of people in the United States Suffer brain injuries. More than half are bad enough that people must go to the hospital. The worst injuries can lead to permanent brain damage or death.half of all traumatic brain injuries (tbis) are due to motor vehicle accidents. Military personnel are also at risk. Symptoms of a tbi may not appear until days or weeks following the injury. Serious traumatic brain injuries need emergency treatment.treatment and outcome depend on the injury. Tbi can cause a wide range of changes affecting thinking, sensation, language, or emotions. Tbi can be associated with post-traumatic stress disorder. People with severe injuries usually need rehabilitation.
     S06 Intracranial injury
     S06.0 Concussion
     S06.1 Traumatic cerebral edema

     S06.2 Diffuse traumatic brain injury

     S06.3 Focal traumatic brain injury
     S06.4 Epidural hemorrhage
     S06.5 Traumatic subdural hemorrhage
     S06.6 Traumatic subarachnoid hemorrhage
     S06.8 Other specified intracranial injuries
     S06.9 Unspecified intracranial injury

    _______________________________________________________________________________________

    Compression of brain

      2016 2017 Billable/Specific Code
      http://www.icd10data.com/ICD10CM/Codes/G00-G99/G89-G99/G93-/G93.5
    • G93.5
    •  is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
    • This is the American ICD-10-CM version of G93.5. Other international versions of ICD-10 G93.5 may differ.
    • Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.

    Applicable To 
    • Arnold-Chiari type 1 compression of brain
    • Compression of brain (stem)
    • Herniation of brain (stem)
    Approximate Synonyms 
    • Arnold Chiari Type 1
    • Brain compression
    • Brain compression due to focal lesion
    • Brain stem compression
    • Brain stem herniation
    • Cerebellar pressure cone
    • Cerebellar tonsil hernia into foramen magnum
    • Cerebral herniation
    • Cerebral herniation tonsillar, into foramen magnum
    • Chiari malformation type I
    • Compression of brain due to focal lesion
    • Compression of brain due to nontraumatic intracerebral hemorrhage
    • Hernia of cerebellar tonsil into foramen magnum
    • Herniation brain stem
    • Herniation cerebral
    • Herniation tonsillar, into foramen magnum
    • Herniation under falx cerebri
    • Intracerebral hemorrhage w brain compression
    • Intracerebral hemorrhage with brain compression
    • Intracerebral hemorrhage with brain compression and coma
    • Intracerebral hemorrhage, coma
    •    ...  
    Type 1 Excludes 
    • diffuse traumatic compression of brain (S06.2-)
    • focal traumatic compression of brain (S06.3-)
    ICD-10-CM G93.5 is grouped within Diagnostic Related Group(s) (MS-DRG v34.0):
    • 080 Nontraumatic stupor and coma with mcc
    • 081 Nontraumatic stupor and coma without mcc

  • rwillcuttrwillcutt
    As of Oct 1, 2016, you are unable to use cerebral herniation (compression) in trauma cases.  Makes absolutely no sense and it really hurt maximizing those DRGs in our trauma institute. 
  • twittig@hcscoding.nettwittig@hcscoding.net
    The patient has a traumatic SDH and is also documented as having a brain herniation.  Brain compression is not documented by the provider.  As far as indexing goes, if you index Hernia, Brain , there is no sub-entry for traumatic. The question I have is, can you then assume that the brain herniation is the same as a brain compression?  Because if you index Compression, Brain there is a sub-entry for traumatic. Whereas, there is no sub-entry for traumatic under Hernia, Brain. 
  • rwillcuttrwillcutt
    Refer to your Excludes 1 notes under brain herniation.  Traumatic is excluded. 

    G93.5 Compression of brain
    Excludes1:
    diffuse traumatic compression of brain (S06.2-)
    focal traumatic compression of brain (S06.3-)

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