PROCEDURE

The consent form was signed by the parents, and the patient was taken to the operating room. She was anesthetized, and the right frontotemporal region was prepped and draped. A burr hole, using a rounded tip, was made into the skull. Immediate evacuation and decompression resulted. The patient’s vitals were stable, and she was discharged to the neurosurgeon for evaluation of a craniotomy.

Note: External cause code(s) apply.

ICD-10 code
S06.5x9A
ICD-10 code
S06.5x9D
ICD-10 code
S06.5x9S

1 answer

ICD-10 code: S06.5x9A - Unspecified intracranial injury, right side, initial encounter
ICD-10 code: S06.5x9D - Unspecified intracranial injury, right side, subsequent encounter
ICD-10 code: S06.5x9S - Unspecified intracranial injury, right side, sequela
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