U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

National Health Statistics Reports

Number 89  January 22, 2016

Proposed Framework for Presenting Injury Data

 Using the International Classification of Diseases, 

Tenth Revision, Clinical Modification (ICD–10–CM) 

Diagnosis Codes

by Holly Hedegaard, M.D., M.S.P.H., National Center for Health Statistics; Renee L. Johnson, R.P.T., M.S.P.H., National 

Center for Injury Prevention and Control; Margaret Warner, Ph.D. and Li-Hui Chen, M.S., Ph.D., National Center for 

Health Statistics; and J. Lee Annest, M.S., Ph.D., National Center for Injury Prevention and Control 

Abstract

Frameworks based on the International Classification of Diseases (ICD) provide 

injury researchers and epidemiologists with standard approaches for presenting and 

analyzing injury-related mortality and morbidity data. Injury diagnosis frameworks, 

such as the Barell Matrix for the ICD Ninth Revision, Clinical Modification 

(ICD–9–CM) and the Injury Mortality Diagnosis Matrix for the ICD Tenth Revision 

(ICD–10), categorize ICD codes into major body region (e.g., head, chest, abdomen, 

or extremity) by nature-of-injury (e.g., fracture, laceration, organ injury, or vascular 

injury) categories. In the United States, morbidity coding transitioned from ICD–9–

CM to ICD–10–CM on October 1, 2015. In preparation for the use of ICD–10–CMcoded morbidity data for injury surveillance and data analysis, the National Center for 

Health Statistics and the National Center for Injury Prevention and Control propose an 

ICD–10–CM Injury Diagnosis Matrix to provide a standard approach for categorizing 

injuries by body region and nature of injury. This report provides a brief description 

of the differences between ICD–9–CM and ICD–10–CM injury diagnosis codes, 

introduces the proposed framework and the methods used to create it, and provides a 

list of additional considerations for review and comment by researchers and subjectmatter experts in injury data and surveillance. 

Keywords: injury diagnosis • classification • traumatic brain injury

Introduction

Since the early 1990s, the Centers 

for Disease Control and Prevention’s 

(CDC’s) National Center for Health 

Statistics (NCHS) and National Center 

for Injury Prevention and Control 

(NCIPC) have collaborated with 

colleagues from the International 

Collaborative Effort (ICE) on Injury 

Statistics and the American Public 

Health Association Injury Control and 

Emergency Health Services section to 

improve the analysis and usefulness 

of fatal and nonfatal injury data in 

the United States and internationally. 

One aspect of this collaboration is 

the development of frameworks or 

matrices based on standard groupings of 

International Classification of Diseases 

(ICD) codes for presenting fatal and 

nonfatal injury data by external causes of 

injury (mechanism and intent of injury) 

and by injury diagnosis (body region 

and nature of injury) (1). Since 1999, 

the 10th revision of ICD (ICD–10) has 

been used in the United States for coding 

death certificate data and, since 1979, the 

Clinical Modification of the 9th revision 

of ICD (ICD–9–CM) has been used to 

code morbidity data (2). Matrices have 

been developed for injury mortality 

data based on ICD–9 and ICD–10 codes 

and for injury morbidity data based on 

ICD–9–CM codes (1,3,4). These matrices 

are used extensively for state, national, 

and international studies of injury by 

external cause and by diagnosis. For 

example, reporting categories from the 

matrices are used in CDC WISQARS 

(5), CDC WONDER (6), CDC Injury 

Indicators Reports (7), and in the work of 

ICE on Injury Statistics (8). 

The Department of Health and 

Human Services has required that 

the Clinical Modification of the 

10th revision of ICD (ICD–10–CM) 

replace ICD–9–CM in the United 

States for coding of morbidity data 

beginning October 1, 2015. From 

that date forward, all hospitals and 

health care providers covered by 

the Health Insurance Portability and 

Accountability Act (HIPAA) must use 

ICD–10–CM when reporting medical 
Page 2 National Health Statistics Reports  Number 89  January 22, 2016

diagnosis information (9). ICD–10–

CM, developed by NCHS for use in 

morbidity coding in the United States, 

has been publicly available for more than 

a decade (10). The coding structure of 

ICD–10–CM is foundationally based on 

ICD–10 published by the World Health 

Organization, however, the classification 

scheme has been greatly expanded to 

capture the diagnostic detail needed in 

morbidity data. ICD–10–CM contains 

nearly five times the number of codes 

found in ICD–9–CM (approximately 

68,000 codes in ICD–10–CM compared 

with 14,000 codes in ICD–9–CM).

Because ICD–10–CM provides much 

greater detail about diagnoses and 

conditions, this classification system 

will potentially provide greater utility 

than either ICD–9–CM or ICD–10 in 

capturing detailed information for billing, 

documentation of clinical care, and public 

health surveillance and practice.

The transition to ICD–10–CM coded 

data creates a need for a standardized 

matrix for presenting injury morbidity 

data by body region and nature of injury 

based on ICD–10–CM codes. This report 

describes the work of injury coding 

and surveillance experts from NCHS 

and NCIPC to develop such a proposed 

matrix. The purpose of the matrix is 

to provide: 1) a standard framework 

of ICD–10–CM code groupings by 

body region and nature of injury for 

presentation and analysis of injury 

morbidity data; and 2) reasonable 

comparability with both the ICD–9–CM 

and ICD–10 injury diagnosis matrices. 

Once tested and finalized, the ICD–10–

CM injury diagnosis matrix will facilitate 

a standardized approach to reporting 

surveillance trends and patterns in 

nonfatal injury in the United States and 

internationally.

This report briefly describes the 

differences between ICD–9–CM and 

ICD–10–CM classification systems for 

injury diagnosis codes, the methods 

used to construct the proposed ICD–

10–CM injury diagnosis matrix, and 

considerations that will require additional 

review and testing when ICD–10–CM 

coded data become available. The focus 

of this report is on the diagnosis codes 

and the development of a framework 

for reporting injury morbidity data by 

body region and nature of injury. A 

companion document released in April 

2014 describes ICD–10–CM external 

cause codes and a proposed framework 

for reporting ICD–10–CM coded data by 

mechanism and intent of injury (11).

Nature of Injury Codes: 

Differences Between 

ICD–9–CM and ICD–10–

CM

ICD–10–CM contains nearly five 

times the number of codes found in 

ICD–9–CM. Most of the expansion in 

the overall number of codes occurred 

in the injury chapters, with an increase 

in the injury diagnosis codes from 

approximately 2,600 codes in ICD–9–

CM to 43,000 codes in ICD–10–CM, 

and an increase in the external cause 

codes from approximately 1,300 codes in 

ICD–9–CM to 7,500 codes in ICD–10–

CM (12). 

Injury diagnosis codes in ICD–10–

CM differ from those in ICD–9–CM in 

a number of ways. A brief description 

of some of these differences is provided 

below and summarized in Table A. 

Relevant chapters of ICD

Injury diagnosis codes are found 

in Chapter 17, “Injury and Poisoning,” 

in ICD–9–CM. In ICD–10–CM, 

the codes are found in Chapter 19, 

“Injury, Poisoning, and Certain Other 

Consequences of External Causes.” 

Change in axis

In the development of ICD–10, a 

substantial change occurred in how the 

injury codes are structured. In ICD–9 

and ICD–9–CM, the primary axis of 

the injury diagnosis codes is the nature 

of injury; in contrast, in ICD–10 and 

ICD–10–CM, the primary axis is the 

body region. For example, in ICD–9–

CM, all codes for fractures are grouped 

together, with subsets of the codes used 

to specify different body regions (e.g., 

head and neck, torso, and extremities). 

In contrast, in ICD–10–CM, all injuries 

to the head and neck, for example, are 

grouped together with subsets of the 

codes used to specify different types of 

Table A. Summary of differences between ICD–9–CM and ICD–10–CM for injury diagnoses

ICD–9–CM ICD–10–CM

2,600 codes 43,000 codes

Injury codes found in Chapter 17 Injury codes found in Chapter 19

Code range 800–999 S and T codes

Three to five characters Three to seven characters; “X” placeholder

Primary axis is nature of injury Primary axis is body region

No character to indicate laterality Characters indicate left, right, bilateral, or 

unspecified laterality

Limited information on type of fracture Detailed information on type of fracture

Laceration codes do not include information on 

presence of a foreign body

Laceration codes include information on presence 

of a foreign body

Limited information on superficial injuries Detailed information on superficial injuries

Codes for poisoning and adverse effects of drugs Codes for poisoning, adverse effects and 

underdosing of drugs

Coding of poisoning requires both a diagnosis 

code and an external cause code

Coding of poisoning uses a diagnosis code (T code) 

only; a character in the code specifies intent

Single diagnosis code for asphyxiation More than 40 diagnosis codes for asphyxiation or 

strangulation by different mechanisms and intents

Codes for confirmed child or adult abuse only Codes for both confirmed and suspected child or 

adult abuse

No designation of initial versus subsequent 

encounter

Most codes have a seventh character indicating 

initial versus subsequent encounter

Limited late effect codes Most codes have a seventh character indicating 

sequelae (late effects) of the injury

NOTES: ICD–9–CM is International Classification of Diseases, Ninth Revision, Clinical Modification. ICD–10–CM is International 

Classification of Diseases, Tenth Revision, Clinical Modification.
National Health Statistics Reports  Number 89  January 22, 2016 Page 3

injuries (e.g., open wounds, fractures, and 

internal organ injuries).

Code structure

The injury diagnosis codes in ICD–

9–CM are numeric codes in the range of 

800–999. The codes include three to five 

characters with a decimal between the 

third and fourth characters. In contrast, 

the ICD–10–CM injury diagnosis 

codes are alphanumeric and begin 

with the letters “S” or “T” signifying 

that the code is found in Chapter 19 

of ICD–10. S codes identify different 

types of injuries related to a single body 

region and T codes identify injuries to 

multiple or unspecified body regions 

as well as poisoning and certain other 

consequences of external causes. ICD–

10–CM injury diagnosis codes have up 

to seven characters, allowing for greater 

specificity of information carried in the 

code. As with ICD–9–CM, for codes 

with four characters or more, a decimal 

is placed between the third and fourth 

character. A new feature of ICD–10–CM 

codes is the use of one or more “dummy” 

characters (“X”) either embedded in the 

code or at the end of the code. The X 

characters are placeholders that represent 

additional characters that may be 

assigned as needed to accommodate new 

codes for specific diagnoses.

The structure of the ICD–10–CM 

injury diagnosis codes reflects the change 

in primary axis from nature of injury to 

body region. For S codes, the second 

character indicates the major body region 

involved, and the third character indicates 

the broad nature-of-injury categories. 

Further details on the body region and 

nature of injury are provided in the fourth 

through sixth characters of the code. The 

T codes do not follow this structure but 

are grouped based on the nature of injury. 

Code specificity

In ICD–10–CM, additional 

characters are used to capture greater 

specificity about the body region and 

nature of the injury. For example, if 

the third character is “0,” indicating 

“Superficial injury,” the fifth character 

captures greater detail about the type 

of superficial injury (e.g., abrasion, 

blister, contusion, external constriction, 

superficial foreign body, or insect bite). 

If the third character is “1,” indicating 

“Open wound,” the fifth character is used 

to identify whether the open wound was 

a laceration, puncture wound, or bite, 

and whether a foreign body was present. 

When applicable, additional characters 

are used to identify laterality (e.g., left, 

right, bilateral, or unspecified) and type 

of fracture (e.g., comminuted, displaced, 

elevated, fissured, greenstick, linear, or 

spiral for closed fractures; or compound, 

infected, or missile for open fractures).

T codes

T codes are used to categorize 

injuries involving multiple or unspecified 

body regions; effects of foreign bodies; 

burns and corrosions; frostbite; poisoning 

by, adverse effects of, and underdosing 

of drugs and biological substances; toxic 

effects of nonmedicinal substances; other 

and unspecified effects of external causes 

such as radiation, vibration, effects of 

lightning, asphyxiation, hypothermia, 

drowning, and nonfatal submersion; 

certain early complications of trauma; 

and complications of surgical and 

medical care, not elsewhere classified. 

Compared with ICD–9–CM, the codes 

for the effects of many of these external 

causes have been greatly expanded 

in ICD–10–CM. For example, while 

a single diagnosis code was used in 

ICD–9–CM to identify asphyxiation and 

strangulation (code 994.7), approximately 

40 codes are available in ICD–10–CM to 

describe asphyxiation and strangulation 

by different mechanisms (e.g., pillow, 

plastic bag, bed linens, another person in 

the bed, furniture, hanging, mechanical 

threat to breathing, being trapped in a car 

trunk, or being trapped in a refrigerator) 

and intents (e.g., accidental, intentional 

self-harm, homicide, or undetermined). 

Combination codes that 

describe both diagnosis and 

mechanism

Many of the T codes are considered 

combination codes because they describe 

both a diagnosis as well as a mechanism 

and intent of injury. One example is 

the set of codes for poisoning and toxic 

effects. In ICD–9–CM, two codes were 

required to describe each drug poisoning 

event—a diagnosis code (960–979 and 

980–989) to describe the type of drug or 

toxic substance involved and an external 

cause code (E850–E858, E860–E869, 

E930–E949, E950–E952, E961–E962, 

and E980–E982) to describe the intent of 

the poisoning (e.g., accidental, intentional 

self-harm, homicide, or undetermined) 

or adverse effect. In ICD–10–CM, the 

information about both the drug involved 

and the intent are captured in a single 

code (T36–T50 for Drugs, medicaments 

and biological substances, and T51–65 

for Toxic effects of substances chiefly 

nonmedicinal as to source). Other 

combination codes in ICD–10–CM 

include T15–19, Effects of foreign body 

entering through natural orifice; T71, 

Asphyxiation; T73, Effects of other 

deprivation; T75.0, Effects of lightning; 

T75.2, Effects of vibration; and T75.3, 

Motion sickness. Because they include 

information on both diagnosis and 

mechanism, all combination codes will 

be found in both the proposed ICD–10–

CM diagnosis matrix and the proposed 

ICD–10–CM external cause matrix. 

Codes for poisoning and 

toxic effects

A new consideration in ICD–10–CM 

is the concept of underdosing. Although 

both ICD–9–CM and ICD–10–CM 

include codes to describe poisoning 

(overdosing) and adverse effects of 

drugs, ICD–10–CM also includes codes 

for underdosing of a drug. The codes 

related to underdosing are used to capture 

harmful events that happen when an 

inadequate amount of a drug was taken 

(e.g., insulin). The underdosing code 

would only be assigned if some type 

of problem occurred (e.g., seizures or 

hyperglycemia). Regarding toxic effects 

of carbon monoxide (T58 in ICD–10–

CM), ICD–10–CM includes more 

subcategories identifying the source of 

the carbon monoxide (e.g., motor vehicle 

exhaust, utility gas, domestic fuels, 

other, or unspecified sources) than were 

available in ICD–9–CM. 

Type of medical encounter

Most of the injury diagnosis codes 

include a seventh character (a letter) that 

specifies whether the injury diagnosis 
Page 4 National Health Statistics Reports  Number 89  January 22, 2016

is related to the initial medical care 

encounter (A, B, or C), a subsequent 

encounter (D to R), or a sequela (S) of 

the injury event.

● The seventh character A, B, or C for 

initial encounter is used while the 

patient is receiving active treatment 

for the condition. Examples of active 

treatment include surgical treatment, 

emergency department encounter, 

and evaluation and continuing 

treatment by the same or a different 

physician. 

● The seventh character D to R for 

subsequent encounter is used for 

encounters after the patient has 

received active treatment for the 

condition and is receiving routine 

care during the healing or recovery 

phase. Examples of subsequent 

care include: cast change or 

removal, removal of external or 

internal fixation device, medication 

adjustment, and other aftercare and 

follow-up visits following treatment 

of the injury or condition. 

● The seventh character S for sequelae 

is used for complications or 

conditions that arise as a direct result 

of an injury, such as scar formation 

after a burn. The scars are sequelae 

of the burn. When using the seventh 

character S, it is necessary to use 

both the injury code that precipitated 

the sequela and the code for the 

sequela itself. The S is added only 

to the injury code, not the sequela 

code. The ICD–10–CM sequela 

designation is equivalent to what was 

coded as a “late effect” in ICD–9–

CM (codes 905–909).

Injury diagnosis codes in ICD–10–

CM also differ slightly from those 

found in ICD–10. In the development 

of ICD–10–CM, various codes found in 

ICD–10 were deactivated and therefore 

are not included in ICD–10–CM. 

Reasons for deactivation include: 1) the 

concept was mortality-specific (e.g., S18, 

Traumatic amputation at neck level); 

2) the code was combined with another 

code elsewhere in the classification (e.g., 

the external cause of injury code W43, 

Vibration was deactivated and combined 

with T75.2); or 3) codes representing 

multiple injuries (e.g., S02.7, Multiple 

fractures involving skull and facial 

bones) were deactivated to encourage the 

use of individual codes to describe each 

injury. Additionally, several new codes (at 

the level of the first four characters) were 

added to ICD–10–CM but are not found 

in ICD–10. Lists of these deactivated and 

added codes are provided in Tables I and

II in the Technical Notes. 

Methods Used to 

Construct the ICD–10–

CM Injury Diagnosis 

Matrix

The construction of the proposed 

ICD–10–CM injury diagnosis matrix 

involved two phases—the creation of 

the basic framework (rows and columns 

of the matrix) and placement of the 

individual ICD–10–CM codes into the 

cells of the framework. 

Creation of the basic 

framework

The basic framework of injury 

diagnosis matrices consists of rows 

that categorize the body regions and 

columns that categorize the natureof-injury groups. Nature-of-injury 

categories describe the type of anatomic 

or physiologic disruption that occurred 

to the body region, such as a fracture, 

dislocation, open wound, burns, injuries 

to internal organs, and poisoning. The 

two nature-of-injury matrices that 

are widely used in the United States 

are the Barell Matrix for data coded 

with ICD–9–CM (3) and the Injury 

Mortality Diagnosis (IMD) Matrix for 

data coded in ICD–10 (4). While the 

general structure of the Barell and IMD 

Matrices are similar, there are several 

critical differences. These differences 

are summarized in Table B and briefly 

described below. 

● The number and types of nature-ofinjury categories differ between the 

Barell (ICD–9–CM) and the IMD 

(ICD–10) Matrices. For example, 

the Barell Matrix includes natureof-injury categories (columns) for 

Sprains and strains. Because these 

types of injuries are rarely mentioned 

on death certificates, this nature-ofinjury category is not included in 

the IMD Matrix. Rather, in the IMD 

Matrix, the codes for these injuries 

are included in the broader category 

of Other specified injury. In contrast 

to the Barell Matrix, the IMD Matrix 

has additional categories (columns) 

for Effects of foreign bodies entering 

orifice, Other effects of external 

causes, Poisoning, Toxic effects, 

Multiple injuries, and Other specified 

injury. These columns are not 

included in the Barell Matrix. These 

differences are partly due to new 

codes in ICD–10 that did not exist 

in ICD– 9–CM, as well as increased 

interest and emphasis on certain 

types of injuries (e.g., poisoning). 

Table B. Differences between the Barell Matrix and the Injury Mortality Diagnosis Matrix

Characteristic Barell Matrix IMD Matrix

Type of data ICD–9–CM (morbidity data) ICD–10 (mortality data)

Nature-of-injury columns1 13 16

Unique nature-of-injury 

columns1

Sprains and strains

Nerves

Foreign body 

Other effects 

Poisoning 

Toxic effects 

Multiple injuries 

Other specified injury

Unique body region rows1 Traumatic brain injury Type 1, 

2, and 3

...

Frostbite Included with Systemwide 

injuries

Included across body regions

Sequelae (late effects) of 

injuries

Included with Systemwide 

injuries

Included with their respective 

diagnoses and across body 

regions

... Category not applicable.

1

Based on the layout of the Barell Matrix and IMD Matrix as presented in “Injury in the United States: 2007 Chartbook,” available 

from: http://www.cdc.gov/nchs/data/misc/injury2007.pdf.

NOTES: IMD is Injury Mortality Diagnosis. ICD–9–CM is International Classification of Diseases, Ninth Revision, Clinical 

Modification. ICD–10 is International Classification of Diseases, Tenth Revision.
National Health Statistics Reports  Number 89  January 22, 2016 Page 5

● The number and type of body 

regions also differ between the two 

matrices. The primary difference is 

with traumatic brain injury (TBI). 

In the Barell Matrix, there are 

three subcategories for TBI—Type 

1, Type 2, and Type 3—based on 

whether there was a skull fracture 

only, an intracranial injury with 

or without a skull fracture, or loss 

of consciousness, and if loss of 

consciousness did occur, the length 

of time of loss of consciousness. 

These distinctions were not included 

in the IMD Matrix, generally 

because the IMD Matrix is used 

to report data on deaths, so these 

distinctions are not relevant.

● Other differences between the Barell 

and IMD Matrices are somewhat 

subtle and specific to certain 

injury diagnoses. For example, the 

categorization of frostbite injuries 

differs in the two matrices. In the 

Barell Matrix, frostbite injuries are 

included in the Systemwide body 

region category, while in the IMD 

Matrix, they are included in the 

Other effects of external causes 

nature-of-injury category and 

distributed across the different body 

regions. 

● Sequelae, or late effects of injuries, 

are handled differently between the 

two matrices. In the Barell Matrix, 

these codes are included in the 

Systemwide body region category, 

while in the IMD Matrix, these codes 

are included in the same body region 

and nature-of-injury cell as the 

associated acute injury code.

Because surveillance data are 

frequently used to monitor trends over 

time or to compare fatal and nonfatal 

outcomes for the same injury, the 

ICD–10–CM injury diagnosis matrix 

needs to be reasonably comparable to the 

existing matrices used for standardized 

reporting of injury data. After reviewing 

the differences between the Barell 

(ICD–9–CM) and IMD (ICD–10) 

Matrices, it was decided to base the 

structure of the proposed ICD–10–CM 

injury diagnosis matrix on the structure 

of the IMD Matrix, adjusting as needed 

by adding rows or columns for greater 

comparability with the Barell Matrix. 

This approach resulted in the body 

region rows and the nature-of-injury 

columns shown in the Figure. There 

are six major body region categories 

(Head and neck, Spine and back, Torso, 

Extremities, Unclassifiable by body 

region, and Unspecified) that are further 

subcategorized into up to two additional 

levels of body regions to provide greater 

specificity if needed. There are 15 major 

nature-of-injury categories, 2 of which 

are further subdivided into subcategories 

because of the level of specificity 

available in the codes (Burns and 

corrosions, divided into separate columns 

for Burns and for Corrosions; and Other 

specified injury, divided into separate 

columns for Sprains and strains, Injury 

to nerves, Injury to muscles and tendons, 

and Other injury). 

Placement of the individual 

ICD–10–CM codes into the 

framework

Several guiding principles were 

used to place the individual ICD–10–CM 

nature-of-injury codes into the cells of the 

matrix. Many of the guiding principles 

are based on the relationship of the 

ICD–10–CM code to the ICD–10 code 

from which it was derived, that is, the 

first four digits. In this section, “parent” 

code refers to the first four characters of 

an ICD–10 or ICD–10–CM code.

● Because the underlying structure of 

the ICD–10–CM matrix is based on 

that of the IMD Matrix for ICD–10, 

in general, a code was first placed in 

the same cell as the parent code in 

the IMD Matrix. 

● Comparable code location in the 

Barell (ICD–9–CM) Matrix was 

also considered. The General 

Equivalence Mappings (GEMs) 

developed by NCHS were used to 

identify the equivalent ICD–9–CM 

code(s) for each ICD–10–CM 

code (2). GEMs are a code-to-code 

reference dictionary that offers 

possible translation alternatives 

between different versions of ICD. 

The body region and nature-of-injury 

location of the ICD–9–CM GEMs 

equivalent in the Barell Matrix 

was then determined. Most codes 

showed agreement between the IMD 

(ICD–10) and Barell Matrices in 

terms of body region and natureof-injury categories. However, for 

some codes, the ICD–9–CM GEMs 

equivalent was found in a different 

cell in the Barell Matrix than the 

ICD–10 parent code in the IMD 

Matrix. When this occurred, the 

ICD–10–CM code in the proposed 

ICD–10–CM matrix was moved 

from the location of the parent code 

found in the IMD Matrix to the 

comparable location of the ICD–9–

CM GEMs equivalent code in the 

Barell Matrix. Thus, for some codes, 

the location of the ICD–10–CM code 

in the proposed ICD–10–CM injury 

diagnosis matrix will differ from that 

of the parent ICD–10 code in the 

IMD Matrix. 

● Special attention was given to the 

codes categorized as TBI. In 2013, 

a workgroup of epidemiologists 

and coding experts from NCHS and 

NCIPC developed a proposed ICD–

10–CM surveillance definition for 

TBI morbidity (see Technical Notes

for further details). The proposed 

code set is based on the GEMs 

equivalents of the codes used in the 

ICD–9–CM surveillance definition 

for TBI morbidity. The codes in the 

proposed ICD–10–CM surveillance 

definition for TBI are shown in Table 

C. For consistency, the code set 

developed by the TBI workgroup has 

been incorporated into the proposed 

ICD–10–CM injury diagnosis 

matrix. The code set for the proposed 

ICD–10–CM surveillance definition 

for TBI morbidity differs from the 

code set for the ICD–10 surveillance 

definition for TBI mortality in the 

IMD Matrix. The codes included in 

the ICD–10 surveillance definition 

for TBI mortality include a wide 

range of ICD–10 codes, many of 

which are less detailed than the ICD–

10–CM codes. The IMD Matrix was 

developed for use with mortality data 

collected from death certificates in 

which detailed anatomic information 

is sometimes limited. While the 

decision to include a wider range of 

codes is appropriate for data from 

death certificates, the more detailed 

injury diagnosis information found 

in medical records and the specificity 

of the ICD–10–CM codes allow for 
Page 6 National Health Statistics Reports  Number 89  January 22, 2016

Figure. Conceptual framework for the proposed ICD–10–CM injury diagnosis matrix

 
National Health Statistics Reports  Number 89  January 22, 2016 Page 7

Figure. Conceptual framework for the proposed ICD–10–CM injury diagnosis matrix–Con.

 
Page 8 National Health Statistics Reports  Number 89  January 22, 2016

a more refined approach to selecting 

appropriate codes for classifying 

TBI morbidity. It is important to 

recognize that there are ICD–10 

codes included in the TBI mortality 

definition and designated as such 

in the TBI body region of the IMD 

Matrix that are not included in the 

TBI body region in the proposed 

ICD–10–CM injury diagnosis 

matrix. These codes are shown in 

Table D. 

● Given the greater detail provided in 

the ICD–10–CM code description, 

some codes previously categorized 

to less specific categories in the 

Barell or IMD Matrices, such as 

Unclassifiable by body region or 

Other specified injury, can be placed 

in more specific cells in the proposed 

ICD–10–CM injury diagnosis 

matrix.

Table E shows examples of ICD–10–

CM codes that are located in a different 

cell than that of the parent code in the 

IMD Matrix. 

The Proposed ICD–10–

CM Injury Diagnosis 

Matrix

The basic framework of the proposed 

ICD–10–CM injury diagnosis matrix is 

defined by the body regions (rows) and 

nature-of-injury (columns) categories 

summarized in the Figure. Using the 

guiding principles, individual codes were 

assigned to the appropriate cell of the 

matrix. The assignment of each ICD–10–

CM diagnosis code to a particular body 

region and nature-of-injury category is 

presented in the accompanying CSV file 

(ftp://ftp.cdc.gov/pub/Health_Statistics/

NCHS/Program_Code/oae/). The file 

includes a listing of each ICD–10–CM 

injury diagnosis code. For each code, 

information is provided on the injury 

diagnosis associated with the code; the 

assigned body region categories 

(Level 1, Level 2 and when applicable, 

Level 3); the assigned nature-of-injury 

categories (Level 1, and when applicable, 

Level 2); and a notation indicating 

whether the location of the ICD–10–CM 

code in the proposed ICD–10–CM injury 

diagnosis matrix differs from that of the 

ICD–10 parent code in the IMD Matrix.

Additional 

Considerations

While most issues regarding the 

inclusion and placement of codes in the 

ICD–10–CM Injury Diagnosis Matrix 

have been addressed, some unresolved 

issues remain. Resolution of these 

issues will require further testing and 

analysis using data coded in ICD–10–

CM or dually coded in ICD–9–CM 

and ICD–10–CM. A few of the items 

for consideration are discussed in the 

following sections.

Traumatic brain injury 

As noted previously, a workgroup 

comprising injury epidemiologists 

and coding experts from NCHS and 

NCIPC created a proposed list of 

ICD–10–CM codes to include in the 

ICD–10–CM surveillance definition 

for TBI morbidity. The TBI workgroup 

currently does not recommend the 

inclusion of subcategories of TBI 

(i.e., the subcategories of Type 1, 2, and 

3 TBI found in the Barell [ICD–9–CM] 

Matrix). However, these decisions were 

made without the benefit of seeing how 

ICD–10–CM codes are implemented in 

actual coded data. This recommendation 

may change as more information 

becomes available. 

Underdosing of drugs

Another unresolved issue is whether 

the injury definition should include the 

extensive number of codes that deal with 

adverse effects of drugs and conditions 

resulting from underdosing of drugs. 

These codes are in the same general 

family as the poisoning (overdosing) 

codes, but many epidemiologists and 

researchers argue that adverse effects and 

underdosing should not be considered 

as injuries and, therefore, should not be 

included in the injury diagnosis matrix. 

They are not included in either the Barell 

Matrix or the IMD Matrix. This topic 

Table C. Proposed ICD–10–CM surveillance definition for traumatic brain injury

ICD–10–CM code Description

S02.0, S02.1– Fracture of skull

S02.8, S02.91 Fracture of other specified skull and facial bones; Unspecified fracture 

of skull

S04.02, S04.03–, S04.04– Injury of optic chiasm; injury of optic tract and pathways; injury of 

visual cortex

S06– Intracranial injury

S07.1 Crushing injury of skull

T74.4 Shaken infant syndrome

NOTES: “–” indicates any fourth, fifth, or sixth character. Seventh character of “A” or “B” for S02.0, S02.1–, S02.8, and S02.91. 

Seventh character of “A” for S04.02, S04.03–, S04.04–, S06–, S07.1, and T74.4. ICD–10–CM is International Classification of 

Diseases, Tenth Revision, Clinical Modification. 

Table D. ICD–10 codes included in the TBI mortality surveillance definition that are not 

included in the proposed ICD–10–CM TBI morbidity surveillance definition

ICD–10–CM code Description

S01– Open wound of head

S02.3 Fracture of orbital floor

S02.71 Multiple fractures involving skull and facial bones

S07.0 Crushing injury of face

S07.8 Crushing injury of other parts of head

S07.9 Crushing injury of head, part unspecified

S09.71 Multiple injuries of head

S09.8 Other specified injuries of head

S09.9– Unspecified injury of face and head

T90.1, T90.2, T90.4, T90.5, 

T90.8, and T90.9

Sequelae of injuries of head

1

Code is deactivated in ICD–10–CM.

NOTES: “–” indicates any fourth, fifth, or sixth character. ICD–10 is International Classification of Diseases, Tenth Revision. CM is 

Clinical Modification. TBI is traumatic brain injury.
National Health Statistics Reports  Number 89  January 22, 2016 Page 9

requires further input before it can be 

resolved. The codes for adverse effects 

and underdosing codes are not included 

in the proposed ICD–10–CM injury 

diagnosis matrix. 

Sequelae codes

Another pending issue is determining 

where the sequelae codes should be 

placed in the proposed ICD–10–CM 

injury diagnosis matrix—with the nature 

and body region of the parent code, in a 

separate nature-of-injury column entirely, 

or not included in the matrix at all. In 

ICD–9–CM, the number of sequelae 

(i.e., late effect) codes was limited; 

sequelae codes were included in the 

Systemwide body region in the Barell 

Matrix. In contrast, in ICD–10–CM, 

almost every injury diagnosis code 

includes a character that describes 

whether this diagnosis is associated 

with an initial encounter, a subsequent 

encounter, or a sequela of an injury. This 

expansion in the number of sequelae 

codes in ICD–10–CM raises new issues 

regarding how or whether the codes 

should be included in the injury diagnosis 

matrix. In the proposed matrix, only 

codes related to an initial encounter 

(i.e., seventh character of A, B, or C) are 

included. The codes for sequelae (i.e., 

those with a seventh character of S) are 

not currently included in the proposed 

matrix.

Combination codes

As previously described, several T 

codes describe both nature of injury as 

well as mechanism of injury (e.g., the T 

codes for poisoning and asphyxiation). 

These types of T codes are currently 

included in both the proposed ICD–10–

CM external cause matrix and the 

ICD–10–CM injury diagnosis matrix. 

The impact of including the same code in 

two different injury matrices needs to be 

considered. 

International comparisons

It has not yet been determined 

whether the proposed ICD–10–CM 

injury diagnosis matrix will be used for 

international comparisons. Most countries 

have either developed their own clinical 

modification of ICD–10 

(e.g., ICD–10–AM in Australia) or use 

ICD–10 for coding both mortality and 

morbidity data. The proposed ICD–10–

CM injury diagnosis matrix has not yet 

been tested for usefulness in making 

international comparisons.

Conclusions

The proposed ICD–10–CM injury 

diagnosis matrix will help the injury 

research and practice community prepare 

for the transition to ICD–10–CM coded 

morbidity data. Once ICD–10–CM 

coded data are available, the proposed 

ICD–10–CM injury diagnosis matrix 

will be tested to identify any necessary 

changes. Then a revised version will be 

released as a compressed summary table 

showing the body region by nature-ofinjury categories with their respective 

ICD–10–CM code sets, similar to the 

current ICD–9–CM injury diagnosis 

matrix (Barell Matrix). 

In the meantime, NCHS and NCIPC 

welcome comments or suggestions 

from the injury community, particularly 

on the issues listed in the “Additional 

Considerations” section. Comments can 

be submitted to nchsinjury@cdc.gov. 
Page 10 National Health Statistics Reports  Number 89  January 22, 2016 Table E. Examples of codes where placement in the proposed ICD–10–CM matrix differs from placement in the IMD (ICD–10) Matrix Code Description IMD Matrix Proposed ICD–10–CM matrix Reason for change in placement Body region Nature of injury Body region Nature of injury S01– Open wound of head Head and neck—TBI Open wound Head and neck—Other head, face, and neck Open wound This code is not included in the proposed ICD–10–CM surveillance definition for TBI morbidity S02.3 Fracture of orbital floor Head and neck—TBI Fracture Head and neck—Other head, face, and neck Fracture This code is not included in the proposed ICD–10–CM surveillance definition for TBI morbidity S02.92 Unspecified fracture of facial bones Head and neck—TBI Fracture Head and neck—Other head, face, and neck Fracture This code is not included in the proposed ICD–10–CM surveillance definition for TBI morbidity S04.01– Injury of optic nerve Head and neck—TBI Other specified injury Head and neck—Other head, face, and neck Nerves This code is not included in the proposed ICD–10–CM surveillance definition for TBI morbidity S07.0 Crushing injury of face Head and neck—TBI Crushing Head and neck—Other head, face, and neck Crushing This code is not included in the proposed ICD–10–CM surveillance definition for TBI morbidity S07.8 Crushing injury of other parts of head Head and neck—TBI Crushing Head and neck—Other head, face, and neck Crushing This code is not included in the proposed ICD–10–CM surveillance definition for TBI morbidity S07.9 Crushing injury of head, part unspecified Head and neck—TBI Crushing Head and neck—Other head, face, and neck Crushing This code is not included in the proposed ICD–10–CM surveillance definition for TBI morbidity S09.8 Other specified injuries of head Head and neck—TBI Other specified injury Head and neck—Other head, face, and neck Other specified injury This code is not included in the proposed ICD–10–CM surveillance definition for TBI morbidity S09.90– S09.93 Unspecified injury of head, ear, nose, face Head and neck—TBI Unspecified injury Head and neck—Other head, face, and neck Unspecified injury This code is not included in the proposed ICD–10–CM surveillance definition for TBI morbidity S12.9 Fracture of neck, unspecified Head and neck—Neck Fracture Spine and back— Vertebral column injury Fracture For consistency with the GEMs equivalent code 805.00 in the Barell (ICD–9–CM) Matrix S14.2 Injury of nerve root of cervical spine Spine and upper back— Vertebral column injury Internal organ injury Spine and back— Vertebral column injury Nerve For consistency with the GEMs equivalent code 953.0 in the Barell (ICD–9–CM) Matrix S14.3 Injury of brachial plexus Head and neck—Neck Other specified injury Extremities Injury to nerves For consistency with the GEMs equivalent code 953.4 in the Barell (ICD–9–CM) Matrix S15.1– Injury to the vertebral artery Spine and upper back — Vertebral column Blood vessel Head and neck—Neck Blood vessel For consistency with the GEMs equivalent code 900.89 in the Barell (ICD–9–CM) Matrix T28.411 Burn of right ear drum Unspecified Burns Head and neck Burns and corrosions—Burns Additional detail in the ICD–10–CM code allows for greater specificity in placement S33.39 Dislocation of other parts of lumbar spine and pelvis Torso—Pelvis and lower back Dislocation Spine and back— Vertebral column injury Dislocation For consistency with the GEMs equivalent code 839.49 and 839.69 in the Barell (ICD–9–CM) Matrix S26.91 Contusion of heart, unspecified with or without hemopericardium Torso—Thorax Unspecified injury Torso—Chest (thorax) Internal organ For consistency with the GEMs equivalent code 861.01 in the Barell (ICD–9–CM) Matrix T28.9– Corrosions of other and unspecified internal organs Unclassifiable by body region—Multiple body regions Burns Head and neck Burns and corrosions— Corrosions Additional detail in the ICD–10–CM code allows for greater specificity in placement T74.4 Shaken infant syndrome Unclassifiable by body region—Systemwide Other effects of external causes Head and neck—TBI Other effects of external causes This code is included in the proposed ICD–10–CM surveillance definition for TBI morbidity

NOTES: “–” indicates any fourth, fifth, or sixth character. For a full listing of the codes, see ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Program_Code/oae/. ICD–10–CM is International Classification of Diseases, Tenth Revision, Clinical Modification. IMD is Injury Mortality Diagnosis. TBI is traumatic brain injury. ICD–9–CM is International Classification of Diseases, Ninth Revision, Clinical Modification. GEMs is General Equivalence Mappings.
National Health Statistics Reports  Number 89  January 22, 2016 Page 11

References

1. National Center for Health Statistics. 

Injury data and resources: Tools and 

frameworks. Hyattsville, MD. Available 

from: http://www.cdc.gov/nchs/injury/

injury_tools.htm.

2. National Center for Health Statistics. 

Classification of diseases, functioning, 

and disability. Hyattsville, MD. Available 

from: http://www.cdc.gov/nchs/icd.htm.

3. Barell V, Aharonson-Daniel L, Fingerhut 

LA, Mackenzie EJ, Ziv A, Boyko V, et al. 

An introduction to the Barell body region 

by nature of injury diagnosis matrix. Inj 

Prev 8(2):91–6. 2002.

4. Fingerhut LA, Warner M. The ICD–10 

injury mortality diagnosis matrix. Inj Prev 

12(1):24–9. 2006.

5. CDC. Injury prevention & control: Data 

& statistics (WISQARS). Atlanta, GA. 

Available from: http://www.cdc.gov/

injury/wisqars.

6. CDC. CDC WONDER. Atlanta, GA. 

Available from: http://wonder.cdc.gov/.

7. CDC. Injury prevention & control: State 

injury indicators reports. Atlanta, GA. 

Available from: http://www.cdc.gov/

injury/stateprograms/indicators.html. 

8. National Center for Health Statistics. 

Injury data and resources: International 

Collaborative Effort (ICE) on Injury 

Statistics. Hyattsville, MD. Available 

from: http://www.cdc.gov/nchs/injury/

advice.htm. 

9. Centers for Medicare & Medicaid 

Services. ICD–10. Baltimore, MD. 

Available from: http://www.cms.

gov/Medicare/Coding/ICD10/index.

html?redirect=/icd10/.

10. National Center for Health Statistics. 

Classification of diseases, functioning, 

and disability. International Classification 

of Diseases, Tenth Revision, Clinical 

Modification (ICD–10–CM). Hyattsville, 

MD. Available from: http://www.cdc.gov/

nchs/icd/icd10cm.htm. 

11. Annest JL, Hedegaard H, Chen L, Warner 

M, Smalls E. Proposed framework for 

presenting injury data using ICD–10–CM 

external cause of injury codes. 2014. 

Available from: http://www.cdc.gov/

injury/wisqars/pdf/ICD–10–CM_External_

Cause_Injury_Codes-a.pdf. 

12. Carmichael A. ICD–10: The axis of 

classification. 2012. Available from: http://

icd10monitor.com/enews/special-bulletin/

item/305-ICD–10-the-axis-of-classificatio

n?showall=1&limitstart. 
Page 12 National Health Statistics Reports  Number 89  January 22, 2016

Technical Notes

A proposed surveillance 

definition for traumatic brain 

injury using ICD–10–CM 

codes

Surveillance and coding experts 

from the Centers for Disease Control and 

Prevention’s (CDC’s) National Center for 

Health Statistics (NCHS) and National 

Center for Injury Prevention and Control 

(NCIPC) have created a proposed 

surveillance case definition for traumatic 

brain injury (TBI) morbidity using codes 

from the International Classification 

of Diseases, Tenth Revision, Clinical 

Modification (ICD–10–CM). This section 

describes the workgroup’s approach 

and methods to generate the proposed 

ICD–10–CM surveillance case definition 

for TBI.

A few considerations framed the 

development of the proposed definition. 

First, the ICD–10–CM definition should 

be compatible with the ICD–9–CM 

(International Classification of Diseases, 

Ninth Revision, Clinical Modification) 

definition currently in use, so that trends 

in TBI morbidity can continue to be 

monitored.

Second, although ICD–10–CM is 

based on ICD–10, both the structure 

of the codes and the total number of 

codes in ICD–10–CM have increased 

to accommodate the greater specificity 

of the injury diagnosis information 

available in morbidity data. An ICD–10 

surveillance definition for TBI deaths 

has been in use since 1999, however, 

this definition cannot be directly 

adopted for the morbidity definition. 

In developing the mortality definition, 

CDC included a wide range of ICD–10 

codes because diagnosis information on 

death certificates is sometimes limited. 

For example, a code such as S01, Open 

wound of head, when assigned to a death 

is likely appropriate for identifying a 

TBI-related death. This code is often 

assigned to deaths resulting from a 

gunshot wound to the head when no 

further anatomic details are provided on 

the death certificate. However, with the 

enhanced detail available in the ICD–10–

CM codes, some of the ICD–10 codes 

included in the mortality surveillance 

definition (such as S01) might not be 

appropriate for the morbidity definition 

using ICD–10–CM. While aware of 

the ICD–10 codes used in the mortality 

surveillance definition, the workgroup 

took an independent approach to identify 

appropriate ICD–10–CM codes for the 

morbidity definition.

The third consideration was that 

in ICD–10–CM, most codes related to 

injury diagnoses are found in Chapter 

19, “Injury, Poisoning and Certain Other 

Consequences of External Causes.” These 

codes begin with an “S” or “T,” followed 

by up to six additional characters. Codes 

found in other chapters of ICD–10–CM 

(e.g., G44.3, Post-traumatic headache; 

or R40.24x Glasgow Coma Scale, total 

score) might also suggest the presence 

of TBI, however, these codes tend to 

describe signs and symptoms rather than 

anatomic injury. For consistency with 

the existing ICD–9–CM and ICD–10 

surveillance definitions, the workgroup 

chose to limit the initial proposed 

ICD–10–CM definition of TBI to S and 

T codes only, recognizing that testing the 

sensitivity and positive predictive value of 

other ICD–10–CM codes in detecting TBI 

will be needed when ICD–10–CM coded 

data become available. 

The codes included in the current 

ICD–9–CM surveillance definition for 

TBI morbidity served as the starting point. 

The workgroup used General Equivalence 

Maps (GEMs) to identify possible 

ICD–10–CM codes that were comparable 

to the codes in the current ICD–9–CM 

surveillance definition. GEMs were 

applied to the ICD–9–CM surveillance 

definition codes. Each ICD–9–CM code 

mapped to at least one ICD–10–CM code; 

most mapped to more than one possible 

ICD–10–CM code. 

From the 493 unique ICD–9–CM 

codes in the current CDC TBI morbidity 

surveillance definition, 221 unique 

ICD–10–CM codes were identified. 

The reduction in the number of codes in 

ICD–10–CM compared with ICD–9–CM 

is largely due to a change in how loss of 

consciousness is captured in ICD–10–

CM. In ICD–9–CM, information on 

loss of consciousness is reflected in a 

fifth character in the diagnosis code. 

This character describes eight different 

categories of loss of consciousness, 

based on the length of time of the loss of 

consciousness and whether or not the 

patient returned to his or her preexisting 

level of consciousness. These eight 

categories result in eight “variations” for 

each diagnosis code. In ICD–9–CM, the 

fifth character for loss of consciousness 

is included in the diagnosis codes for 

concussion, intracranial injury, and 

skull fracture. In contrast, in ICD–10–

CM, characters describing loss of 

consciousness are only included with 

diagnosis codes for concussion and 

intracranial injury—not skull fracture. 

This change has dramatically reduced the 

number of unique TBI-related codes in 

ICD–10–CM.

The 221 ICD–10–CM codes 

identified from the GEMs analysis were 

compared with the codes included in 

the ICD–10 definition for TBI mortality. 

Of the 221 unique ICD–10–CM codes 

from the GEMs analysis, 220 ICD–10 

equivalents are included in the current 

CDC TBI-related mortality definition. 

The only code for which there was 

an ICD–10–CM code but no ICD–10 

code was T74.4XX, Shaken infant 

syndrome. This code represents the 

GEMs equivalent to the ICD–9–CM code 

995.55, Shaken infant syndrome, which 

is included in the current ICD–9–CM 

TBI morbidity definition.

The comparison of the GEMsderived ICD–10–CM codes with the 

ICD–10 codes in the current TBI 

mortality definition also identified 

possible ICD–10–CM codes that 

should not be included in the morbidity 

definition. In general, these exclusions 

resulted from a less specific ICD–10 code 

or category (e.g., S07, Crushing injury 

of head) being included in the mortality 

definition, with the more specific 

ICD–10–CM code (e.g., S07.0, Crushing 

injury of face) not being appropriate for 

inclusion in the TBI morbidity definition. 

In addition to the method described 

above, workgroup members from 

NCHS and NCIPC independently 

reviewed ICD–10–CM codes to identify 

other possible codes to include in the 

surveillance definition. This process did 

not result in any additional codes being 

added to the proposed code set derived 

from the GEMs analysis. 
National Health Statistics Reports  Number 89  January 22, 2016 Page 13

For the reader’s reference, lists of ICD–10 codes that were deactivated in ICD–10–CM, and new codes that were added to 

ICD–10–CM are listed in Tables I and II, respectively. 

Table I. ICD–10 injury diagnosis codes that are deactivated in ICD–10–CM

Code Description

S00.7 Multiple superficial injuries of head

S01.7 Multiple open wounds of head

S02.7 Multiple fractures involving skull and facial bones

S03.3 Dislocation of other and unspecified parts of head

S03.5 Sprain and strain of joints and ligaments of other and unspecified parts of head

S06.7 Intracranial injury with prolonged coma

S08.9 Traumatic amputation of unspecified part of head

S09.7 Multiple injuries of head

S10.7 Multiple superficial injuries of neck

S11.7 Multiple open wounds of neck

S12.7 Multiple fractures of cervical spine

S13.3 Multiple dislocations of neck

S13.6 Sprain and strain of joints and ligaments of other and unspecified parts of neck

S14.6 Injury of other and unspecified nerves of neck

S15.7 Injury of multiple blood vessels at neck level

S18 Traumatic amputation at neck level

S19.7 Multiple injuries of neck

S20.7 Multiple superficial injuries of thorax

S20.8 Superficial injury of other and unspecified parts of thorax

S21.7 Multiple open wounds of thoracic wall

S21.8 Open wound of other parts of thorax

S22.1 Multiple fractures of thoracic spine

S22.8 Fracture of other parts of bony thorax

S23.5 Sprain and strain of other and unspecified parts of thorax

S24.5 Injury of other nerves of thorax

S24.6 Injury of unspecified nerve of thorax

S25.7 Injury of multiple blood vessels of thorax

S26.8 Other injuries of heart

S27.7 Multiple injuries of intrathoracic organs

S29.7 Multiple injuries of thorax

S30.7 Multiple superficial injuries of abdomen, lower back and pelvis

S31.7 Multiple open wounds of abdomen, lower back and pelvis

S32.7 Multiple fractures of lumbar spine and pelvis

S33.7 Sprain and strain of other and unspecified parts of lumbar spine and pelvis

S35.7 Injury of multiple blood vessels at abdomen, lower back and pelvis level

S36.7 Injury of multiple intra-abdominal organs

S37.7 Injury of multiple pelvic organs

S39.6 Injury of intra-abdominal organ(s) with pelvic organ(s)

S39.7 Other multiple injuries of abdomen, lower back and pelvis

S40.7 Multiple superficial injuries of shoulder and upper arm

S41.7 Multiple open wounds of shoulder and upper arm

S41.8 Open wound of other and unspecified parts of shoulder girdle
Page 14 National Health Statistics Reports  Number 89  January 22, 2016

Table I. ICD–10 injury diagnosis codes that are deactivated in ICD–10–CM

Code Description

S42.7 Multiple fractures of clavicle, scapula and humerus

S42.8 Fracture of other parts of shoulder and upper arm

S43.7 Sprain and strain of other and unspecified parts of shoulder girdle

S44.7 Injury of multiple nerves at shoulder and upper arm level

S45.7 Injury of multiple blood vessels at shoulder and upper arm level

S46.7 Injury of multiple muscles and tendons at shoulder and upper arm level

S49.7 Multiple injuries of shoulder and upper arm

S50.7 Multiple superficial injuries of forearm

S51.7 Multiple open wounds of forearm

S51.9 Open wound of forearm, part unspecified

S52.4 Fracture of shafts of both ulna and radius

S52.7 Multiple fractures of forearm

S52.8 Fracture of other parts of forearm

S54.7 Injury of multiple nerves at forearm level

S55.7 Injury of multiple blood vessels at forearm level

S56.7 Injury of multiple muscles and tendons at forearm level

S59.7 Multiple injuries of forearm

S60.7 Multiple superficial injuries of wrist and hand

S61.7 Multiple open wounds of wrist and hand

S61.8 Open wound of other parts of wrist and hand

S61.9 Open wound of wrist and hand part, part unspecified

S62.4 Multiple fractures of metacarpal bones

S62.7 Multiple fractures of fingers

S62.8 Fracture of other and unspecified parts of wrist and hand

S63.7 Sprain and strain of other and unspecified parts of hand

S64.7 Injury of multiple nerves at wrist and hand level

S66.7 Injury of multiple extensor muscles and tendons at wrist and hand level

S67.8 Crushing injury of other and unspecified parts of wrist and hand

S68.2 Traumatic amputation of two or more fingers alone (complete) (partial)

S68.3 Combined traumatic amputation of (part of) finger(s) with other parts of wrist and hand

S70.7 Multiple superficial injuries of hip and thigh

S70.8 Other superficial injuries of hip and thigh

S71.7 Multiple open wounds of hip and thigh

S71.8 Open wound of other and unspecified parts of pelvic girdle

S72.7 Multiple fractures of femur

S74.7 Injury of multiple nerves at hip and thigh level

S75.7 Injury of multiple blood vessels at hip and thigh level

S76.4 Injury of other and unspecified muscles and tendons at thigh level

S76.7 Injury of multiple muscles and tendons at hip and thigh level

S80.7 Multiple superficial injuries of lower leg

S81.7 Multiple open wounds of lower leg

S81.9 Open wound of lower leg, part unspecified

S82.7 Multiple fractures of lower leg

S83.7 Injury to multiple structures of knee

—Con.
National Health Statistics Reports  Number 89  January 22, 2016 Page 15

Table I. ICD–10 injury diagnosis codes that are deactivated in ICD–10–CM—Con.

Code Description

S84.7 Injury of multiple nerves at lower leg level

S85.7 Injury of multiple blood vessels at lower leg level

S86.7 Injury of multiple muscles and tendons at lower leg level

S89.7 Multiple injuries of lower leg

S90.7 Multiple superficial injuries of ankle and foot

S91.7 Multiple open wounds of ankle and foot

S92.7 Multiple fractures of foot

S93.2 Rupture of ligaments at ankle and foot level

S94.7 Injury of multiple nerves at ankle and foot level

S95.7 Injury of multiple blood vessels at ankle and foot level

S96.7 Injury of multiple muscles and tendons at ankle and foot level

S98.4 Traumatic amputation of foot, level unspecified

S99.7 Multiple injuries of ankle and foot

T00.2 Superficial injuries involving multiple regions of upper limb(s)

T00.3 Superficial injuries involving multiple regions of lower limb(s)

T00.8 Superficial injuries involving other combinations of body regions

T00.9 Multiple superficial injuries, unspecified

T01.2 Open wounds involving multiple regions of upper limb(s)

T01.3 Open wounds involving multiple regions of lower limb(s)

T01.9 Multiple open wounds, unspecified

T02.1 Fractures involving thorax with lower back and pelvis

T02.2 Fractures involving multiple regions of one upper limb

T02.3 Fractures involving multiple regions of one lower limb

T02.4 Fractures involving multiple regions of both upper limbs

T02.5 Fractures involving multiple regions of both lower limbs

T02.8 Fractures involving other combinations of body regions

T02.9 Multiple fractures, unspecified

T03.1 Dislocations, sprains and strains involving thorax with lower back and pelvis

T03.2 Dislocations, sprains and strains involving multiple regions of upper limb(s)

T03.3 Dislocations, sprains and strains involving multiple regions of lower limb(s)

T03.8 Dislocations, sprains and strains involving other combinations of body regions

T03.9 Multiple dislocations, sprains and strains, unspecified

T04.1 Crushing injuries involving thorax with abdomen, lower back and pelvis

T04.2 Crushing injuries involving multiple regions of upper limb(s)

T04.3 Crushing injuries involving multiple regions of lower limb(s)

T04.8 Crushing injuries involving other combinations of body regions

T04.9 Multiple crushing injuries, unspecified

T05.0 Traumatic amputation of both hands

T05.2 Traumatic amputation of both arms (any level)

T05.3 Traumatic amputation of both feet

T05.5 Traumatic amputation of both legs (any level)

T05.8 Traumatic amputations involving other combinations of body regions

T05.9 Multiple traumatic amputations, unspecified

T06.2 Injuries of nerves involving multiple body regions
Page 16 National Health Statistics Reports  Number 89  January 22, 2016

Table I. ICD–10 injury diagnosis codes that are deactivated in ICD–10–CM

Code Description

T06.3 Injuries of blood vessels involving multiple body regions

T06.4 Injuries of muscles and tendons involving multiple body regions

T06.5 Injuries of intrathoracic organs with intra-abdominal and pelvic organs

T08 Fracture of spine, level unspecified

T09.0 Superficial injury of trunk, level unspecified

T09.1 Open wound of trunk, level unspecified

T09.2 Dislocation, sprain and strain of unspecified joint and ligament of trunk

T09.3 Injury of spinal cord, level unspecified

T09.4 Injury of unspecified nerve, spinal nerve root and plexus of trunk

T09.5 Injury of unspecified muscle and tendon of trunk

T09.6 Traumatic amputation of trunk, level unspecified

T09.8 Other specified injuries of trunk, level unspecified

T09.9 Unspecified injury of trunk, level unspecified

T10 Fracture of upper limb, level unspecified

T11.0 Superficial injury of upper limb, level unspecified

T11.1 Open wound of upper limb, level unspecified

T11.2 Dislocation, sprain and strain of unspecified joint and ligament of upper limb, level unspecified

T11.3 Injury of unspecified nerve of upper limb, level unspecified

T11.4 Injury of unspecified blood vessel of upper limb, level unspecified

T11.5 Injury of unspecified muscle and tendon of upper limb, level unspecified

T11.6 Traumatic amputation of upper limb, level unspecified

T11.8 Other specified injuries of upper limb, level unspecified

T11.9 Unspecified injury of upper limb, level unspecified

T12 Fracture of lower limb, level unspecified

T13.0 Superficial injury of lower limb, level unspecified

T13.1 Open wound of lower limb, level unspecified

T13.2 Dislocation, sprain and strain of unspecified joint and ligament of lower limb, level unspecified

T13.3 Injury of unspecified nerve of lower limb, level unspecified

T13.4 Injury of unspecified blood vessel of lower limb, level unspecified

T13.5 Injury of unspecified muscle and tendon of lower limb, level unspecified

T13.6 Traumatic amputation of lower limb, level unspecified

T13.8 Other specified injuries of lower limb, level unspecified

T13.9 Unspecified injury of lower limb, level unspecified

T14.0 Superficial injury of unspecified body region

T14.1 Open wound of unspecified body region

T14.2 Fracture of unspecified body region

T14.3 Dislocation, sprain and strain of unspecified body region

T14.4 Injury of nerve(s) of unspecified body region

T14.5 Injury of blood vessel(s) of unspecified body region

T14.6 Injury of muscles and tendons of unspecified body region

T14.7 Crushing injury and traumatic amputation of unspecified body region

T30.1 Burn of first degree, body region unspecified

T30.2 Burn of second degree, body region unspecified

T30.3 Burn of third degree, body region unspecified

—Con.
National Health Statistics Reports  Number 89  January 22, 2016 Page 17

Table I. ICD–10 injury diagnosis codes that are deactivated in ICD–10–CM

Code Description

T30.5 Corrosion of first degree, body region unspecified

T30.6 Corrosion of second degree, body region unspecified

T30.7 Corrosion of third degree, body region unspecified

T35.0 Superficial frostbite involving multiple body regions

T35.1 Frostbite with tissue necrosis involving multiple body regions

T35.2 Unspecified frostbite of head and neck

T35.3 Unspecified frostbite of thorax, abdomen, lower back and pelvis

T35.4 Unspecified frostbite of upper limb

T35.5 Unspecified frostbite of lower limb

T35.6 Unspecified frostbite involving multiple body regions

T35.7 Unspecified frostbite of unspecified site

T74.8 Other maltreatment syndromes

T79.3 Post-traumatic wound infection, Not Elsewhere Classifiable

T74.8 Other maltreatment syndromes

T79.3 Post-traumatic wound infection, Not Elsewhere Classifiable

NOTE: ICD–10–CM is International Classification of Diseases, Tenth Revision, Clinical Modification.

—Con.
Page 18 National Health Statistics Reports  Number 89  January 22, 2016

Table II. Codes (at fourth character level) not found in ICD–10 but included in ICD–10–CM

Code Description

S03.8 Sprain of joints and ligaments of other parts of head

S03.9 Sprain of joints and ligaments of unspecified parts of head

S09.3 Other specified and unspecified injury of middle and inner ear

S12.3 Fracture of fourth cervical vertebra

S12.4 Fracture of fifth cervical vertebra

S12.5 Fracture of sixth cervical vertebra

S12.6 Fracture of seventh cervical vertebra

S13.8 Sprain of joints and ligaments of other parts of neck

S13.9 Sprain of joints and ligaments of unspecified parts of neck

S14.8 Injury of other specified nerves of neck

S14.9 Injury of unspecified nerves of neck

S16.1 Strain of muscle, fascia and tendon at neck level

S16.2 Laceration of muscle, fascia and tendon at neck level

S16.8 Other specified injury of muscle, fascia and tendon at neck level

S16.9 Unspecified injury of muscle, fascia and tendon at neck level

S21.3 Open wound of front wall of thorax with penetration into thoracic cavity

S21.4 Open wound of back wall of thorax with penetration into thoracic cavity

S23.8 Sprain of other specified parts of thorax

S23.9 Sprain of unspecified parts of thorax

S24.8 Injury of other specified nerves of thorax

S24.9 Injury of unspecified nerve of thorax

S26.1 Injury of heart without hemopericardium

S28.2 Traumatic amputation of breast

S30.3 Contusion of anus

S31.6 Open wound of abdominal wall with penetration into peritoneal cavity

S32.9 Fracture of unspecified parts of lumbosacral spine and pelvis

S33.8 Sprain of other parts of lumbar spine and pelvis

S33.9 Sprain of unspecified parts of lumbar spine and pelvis

S34.9 Injury of unspecified nerves at abdomen, lower back and pelvis level

S40.2 Other superficial injuries of shoulder

S43.8 Sprain of other specified parts of shoulder girdle

S43.9 Sprain of unspecified parts of shoulder girdle

S47.1 Crushing injury of right shoulder and upper arm

S47.2 Crushing injury of left shoulder and upper arm

S47.9 Crushing injury of shoulder and upper arm, unspecified arm

S49.0 Physeal fracture of upper end of humerus

S49.1 Physeal fracture of lower end of humerus

S50.3 Other superficial injuries of elbow

S59.0 Physeal fracture of lower end of ulna

S59.1 Physeal fracture of upper end of radius

S59.2 Physeal fracture of lower end of radius

S60.3 Other superficial injuries of thumb

S60.4 Other superficial injuries of other fingers

S60.5 Other superficial injuries of hand
National Health Statistics Reports  Number 89  January 22, 2016 Page 19

Table II. Codes (at fourth character level) not found in ICD–10 but included in ICD–10–CM

Code Description

S61.2 Open wound of other finger without damage to nail

S61.3 Open wound of other finger with damage to nail

S61.4 Open wound of hand

S61.5 Open wound of wrist

S62.9 Unspecified fracture of wrist and hand

S63.8 Sprain of other part of wrist and hand

S63.9 Sprain of unspecified part of wrist and hand

S67.1 Crushing injury of other and unspecified finger(s)

S67.2 Crushing injury of hand

S67.3 Crushing injury of wrist

S67.4 Crushing injury of wrist and hand

S68.5 Traumatic transphalangeal amputation of thumb

S68.6 Traumatic transphalangeal amputation of other and unspecified finger

S68.7 Traumatic transmetacarpal amputation of hand

S70.2 Other superficial injuries of hip

S70.3 Other superficial injuries of thigh

S76.8 Injury of other specified muscles, fascia and tendons at thigh level

S76.9 Injury of unspecified muscles, fascia and tendons at thigh level

S79.0 Physeal fracture of upper end of femur

S79.1 Physeal fracture of lower end of femur

S80.2 Other superficial injuries of knee

S83.8 Sprain of other specified parts of knee

S83.9 Sprain of unspecified site of knee

S89.0 Physeal fracture of upper end of tibia

S89.1 Physeal fracture of lower end of tibia

S89.2 Physeal fracture of upper end of fibula

T19.4 Foreign body in penis

T71.1 Asphyxiation due to mechanical threat to breathing

T71.2 Asphyxiation due to systemic oxygen deficiency due to low oxygen content in ambient air

T71.9 Asphyxiation due to unspecified cause

T74.4 Shaken infant syndrome

T76.0 Neglect or abandonment, suspected

T76.1 Physical abuse, suspected

T76.2 Sexual abuse, suspected

T76.3 Psychological abuse, suspected

T76.9 Unspecified maltreatment, suspected

T79.4 Traumatic compartment syndrome

NOTE: ICD–10–CM is International Classification of Diseases, Tenth Revision, Clinical Modification.

—Con.
National Health Statistics Reports  Number 89  January 22, 2016

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Acknowledgments

This report was a collaboration of the Centers for Disease Control and Prevention’s (CDC’s) National Center for Health Statistics (NCHS) and 

National Center for Injury Prevention and Control (NCIPC). The authors thank Donna Pickett, M.P.H. and Lois Fingerhut, M.A. for their valuable 

review and comments on this background document and the proposed ICD–10–CM injury diagnosis matrix.

Members of CDC’s Traumatic Brain Injury Surveillance Definition Workgroup include: Holly Hedegaard, M.D., M.S.P.H. and Li-Hui Chen, 

M.S., Ph.D., National Center for Health Statistics; Victor Coronado, M.D., M.P.H., Christopher Taylor, Ph.D., Jeneita Bell, M.D., M.P.H., Lisa 

C. McGuire, Ph.D., J. Lee Annest, M.S., Ph.D., Arlene Greenspan, Ph.D., and Renee L. Johnson, R.P.T., M.S.P.H., National Center for Injury 

Prevention and Control.

Suggested citation

Hedegaard H, Johnson RL, Warner M, et al. 

Proposed framework for presenting injury 

data using the International Classification of 

Diseases, Tenth Revision, Clinical Modification 

diagnosis codes. National health statistics 

reports; no 89. Hyattsville, MD: National 

Center for Health Statistics. 2016.

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