ICD-10 Coding for Concussion(S06.0X0A, S06.0X1A)
Complete ICD-10-CM coding and documentation guide for Concussion. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Concussion
S06.0X0-S06.0X9Primary Range
Concussion with varying durations of loss of consciousness
This range covers all concussion diagnoses with specific codes for different durations of loss of consciousness.
Post-concussive syndrome
Used for sequelae of concussion, indicating persistent symptoms beyond the acute phase.
External causes of falls
These codes are used to specify the external cause of the concussion, such as falls.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S06.0X0A | Concussion without loss of consciousness, initial encounter | Use when a patient is diagnosed with a concussion and there is no loss of consciousness. |
|
| S06.0X1A | Concussion with loss of consciousness of 30 minutes or less, initial encounter | Use when a patient has a concussion with a documented LOC of 30 minutes or less. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for concussion without LOC
Essential facts and insights about Concussion
Primary ICD-10-CM Codes for concussion
Decision Criteria
clinical Criteria
- No loss of consciousness reported by patient or witnesses
Applicable To
- Concussion without LOC
Excludes
- Traumatic brain injury with LOC
Clinical Validation Requirements
- Clinical diagnosis of concussion without any reported LOC
- Negative imaging results
Code-Specific Risks
- Incorrectly coding when LOC is present
Coding Notes
- Ensure documentation clearly states no LOC occurred.
S06.0X1A - Concussion with loss of consciousness of 30 minutes or less, initial encounter
Use when a patient has a concussion with a documented LOC of 30 minutes or less.
Applicable To
- Concussion with brief LOC
Excludes
- Concussion with prolonged LOC
Clinical Validation Requirements
- Documented LOC of 30 minutes or less
- Clinical symptoms consistent with concussion
Coding Notes
Ensure LOC duration is clearly documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Concussion to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S06.0X0A.
Impact
Clinical: Inadequate understanding of injury context, Regulatory: Non-compliance with ICD-10 coding guidelines, Financial: Potential loss of reimbursement for related services
Mitigation Strategy
Always ask about and document the mechanism of injury, Use external cause codes appropriately
Impact
Reimbursement: May lead to incorrect DRG assignment and reimbursement issues., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of health data records.
Mitigation Strategy
Always document and code the specific duration of LOC when available.
Impact
Inaccurate or missing documentation of LOC duration can lead to audit issues.
Mitigation Strategy
Implement standardized documentation protocols for LOC.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Concussion, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Concussion
Use these documentation templates to ensure complete and accurate documentation for Concussion. These templates include all required elements for proper coding and billing.
Initial Evaluation of Concussion in Emergency Department
Specialty: Emergency MedicineRequired Elements
- Mechanism of injury
- Duration of LOC
- Symptoms
- Imaging results
- Plan of care
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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