American College of Emergency Physicians Claims Specifications

Measure #1: Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt Head Trauma for Patients Aged 18 Years and Older

Denominator All emergency department visits for patients aged 18 years and older who presented within 24 (Eligible hours of a minor blunt head trauma with a Glasgow Coma Scale (GCS) score of 15 and who had a Population) head CT for trauma ordered by an emergency care provider

Definition: Presented within 24 hours - The 24 hour timeframe is based on the time of injury reported by the patient or caregiver or guardian.

Denominator note: Minor blunt head trauma includes only non-penetrating injuries.

Age >= 18 years AND CPT® Code for Encounter: 99281, 99282, 99283, 99284, 99285 AND ICD-9-CM Diagnosis Code for non-penetrating head injury (reportable through 9/30/2015): Code Descriptor Closed fracture of vault of skull without mention of intracranial injury, unspecified state of 800.00 consciousness Closed fracture of vault of skull without mention of intracranial injury, with no loss of 800.01 consciousness Closed fracture of vault of skull without mention of intracranial injury, with brief [less than 800.02 one hour] loss of consciousness Closed fracture of vault of skull without mention of intracranial injury, with moderate [1-24 800.03 hours] loss of consciousness Closed fracture of vault of skull without mention of intracranial injury, with loss of 800.06 consciousness of unspecified duration Closed fracture of vault of skull without mention of intracranial injury, with concussion, 800.09 unspecified Closed fracture of vault of skull with cerebral laceration and contusion, unspecified state of 800.10 consciousness Closed fracture of vault of skull with cerebral laceration and contusion, with no loss of 800.11 consciousness Closed fracture of vault of skull with cerebral laceration and contusion, with brief [less than 800.12 one hour] loss of consciousness Closed fracture of vault of skull with cerebral laceration and contusion, with moderate [1-24 800.13 hours] loss of consciousness Closed fracture of vault of skull with cerebral laceration and contusion, with loss of 800.16 consciousness of unspecified duration Closed fracture of vault of skull with cerebral laceration and contusion, with concussion, 800.19 unspecified Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, 800.20 unspecified state of consciousness Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with 800.21 no loss of consciousness Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with 800.22 brief [less than one hour] loss of consciousness Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with 800.23 moderate [1-24 hours] loss of consciousness Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with 800.26 loss of consciousness of unspecified duration Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with 800.29 concussion, unspecified Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, 800.30 unspecified state of consciousness

American College of Emergency Physicians Claims Specifications Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, with no 800.31 loss of consciousness Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, with brief 800.32 [less than one hour] loss of consciousness Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, with 800.33 moderate [1-24 hours] loss of consciousness Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, with loss 800.36 of consciousness of unspecified duration Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, with 800.39 concussion, unspecified Closed fracture of vault of skull with intracranial injury of other and unspecified nature, 800.40 unspecified state of consciousness Closed fracture of vault of skull with intracranial injury of other and unspecified nature, with 800.41 no loss of consciousness Closed fracture of vault of skull with intracranial injury of other and unspecified nature, with 800.42 brief [less than one hour] loss of consciousness Closed fracture of vault of skull with intracranial injury of other and unspecified nature, with 800.43 moderate [1-24 hours] loss of consciousness Closed fracture of vault of skull with intracranial injury of other and unspecified nature, with 800.46 loss of consciousness of unspecified duration Closed fracture of vault of skull with intracranial injury of other and unspecified nature, with 800.49 concussion, unspecified Closed fracture of base of skull without mention of intra cranial injury, unspecified state of 801.00 consciousness Closed fracture of base of skull without mention of intra cranial injury, with no loss of 801.01 consciousness Closed fracture of base of skull without mention of intra cranial injury, with brief [less than 801.02 one hour] loss of consciousness Closed fracture of base of skull without mention of intra cranial injury, with moderate [1-24 801.03 hours] loss of consciousness Closed fracture of base of skull without mention of intra cranial injury, with loss of 801.06 consciousness of unspecified duration Closed fracture of base of skull without mention of intra cranial injury, with concussion, 801.09 unspecified Closed fracture of base of skull with cerebral laceration and contusion, unspecified state of 801.10 consciousness Closed fracture of base of skull with cerebral laceration and contusion, with no loss of 801.11 consciousness Closed fracture of base of skull with cerebral laceration and contusion, with brief [less than 801.12 one hour] loss of consciousness Closed fracture of base of skull with cerebral laceration and contusion, with moderate [1-24 801.13 hours] loss of consciousness Closed fracture of base of skull with cerebral laceration and contusion, with loss of 801.16 consciousness of unspecified duration Closed fracture of base of skull with cerebral laceration and contusion, with concussion, 801.19 unspecified Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, 801.20 unspecified state of consciousness Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with 801.21 no loss of consciousness Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with 801.22 brief [less than one hour] loss of consciousness Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with 801.23 moderate [1-24 hours] loss of consciousness Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with 801.26 loss of consciousness of unspecified duration Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with 801.29 concussion, unspecified Closed fracture of base of skull with other and unspecified intracranial hemorrhage, 801.30 unspecified state of consciousness 801.31 Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with no

American College of Emergency Physicians Claims Specifications loss of consciousness Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with brief 801.32 [less than one hour] loss of consciousness Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with 801.33 moderate [1-24 hours] loss of consciousness Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with loss 801.36 of consciousness of unspecified duration Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with 801.39 concussion, unspecified Closed fracture of base of skull with intracranial injury of other and unspecified nature, 801.40 unspecified state of consciousness Closed fracture of base of skull with intracranial injury of other and unspecified nature, with 801.41 no loss of consciousness Closed fracture of base of skull with intracranial injury of other and unspecified nature, with 801.42 brief [less than one hour] loss of consciousness Closed fracture of base of skull with intracranial injury of other and unspecified nature, with 801.43 moderate [1-24 hours] loss of consciousness Closed fracture of base of skull with intracranial injury of other and unspecified nature, with 801.46 loss of consciousness of unspecified duration Closed fracture of base of skull with intracranial injury of other and unspecified nature, with 801.49 concussion, unspecified 802.0 Closed fracture of nasal bones 802.20 Closed fracture of mandible, unspecified site 802.21 Closed fracture of mandible, condylar process 802.22 Closed fracture of mandible, subcondylar 802.23 Closed fracture of mandible, coronoid process 802.24 Closed fracture of mandible, ramus, unspecified 802.25 Closed fracture of mandible, angle of jaw 802.26 Closed fracture of mandible, symphysis of body 802.27 Closed fracture of mandible, alveolar border of body 802.28 Closed fracture of mandible, body, other and unspecified 802.29 Closed fracture of mandible, multiple sites 802.4 Closed fracture of malar and maxillary bones 802.6 Closed fracture of orbital floor (blow-out) 802.8 Closed fracture of other facial bones Other closed skull fracture without mention of intracranial injury, unspecified state of 803.00 consciousness Other closed skull fracture without mention of intracranial injury, with no loss of 803.01 consciousness Other closed skull fracture without mention of intracranial injury, with brief [less than one 803.02 hour] loss of consciousness Other closed skull fracture without mention of intracranial injury, with moderate [1-24 hours] 803.03 loss of consciousness Other closed skull fracture without mention of intracranial injury, with loss of consciousness 803.06 of unspecified duration Other closed skull fracture without mention of intracranial injury, with concussion, 803.09 unspecified Other closed skull fracture with cerebral laceration and contusion, unspecified state of 803.10 consciousness Other closed skull fracture with cerebral laceration and contusion, with no loss of 803.11 consciousness Other closed skull fracture with cerebral laceration and contusion, with brief [less than one 803.12 hour] loss of consciousness Other closed skull fracture with cerebral laceration and contusion, with moderate [1-24 hours] 803.13 loss of consciousness Other closed skull fracture with cerebral laceration and contusion, with loss of consciousness 803.16 of unspecified duration

American College of Emergency Physicians Claims Specifications Other closed skull fracture with cerebral laceration and contusion, with concussion, 803.19 unspecified Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, 803.20 unspecified state of consciousness Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with no 803.21 loss of consciousness Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with brief 803.22 [less than one hour] loss of consciousness Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with 803.23 moderate [1-24 hours] loss of consciousness Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with loss 803.26 of consciousness of unspecified duration Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with 803.29 concussion, unspecified Other closed skull fracture with other and unspecified intracranial hemorrhage, unspecified 803.30 state of unconsciousness Other closed skull fracture with other and unspecified intracranial hemorrhage, with no loss of 803.31 consciousness Other closed skull fracture with other and unspecified intracranial hemorrhage, with brief [less 803.32 than one hour] loss of consciousness Other closed skull fracture with other and unspecified intracranial hemorrhage, with moderate 803.33 [1-24 hours] loss of consciousness Other closed skull fracture with other and unspecified intracranial hemorrhage, with loss of 803.36 consciousness of unspecified duration Other closed skull fracture with other and unspecified intracranial hemorrhage, with 803.39 concussion, unspecified Other closed skull fracture with intracranial injury of other and unspecified nature, 803.40 unspecified state of consciousness Other closed skull fracture with intracranial injury of other and unspecified nature, with no 803.41 loss of consciousness Other closed skull fracture with intracranial injury of other and unspecified nature, with brief 803.42 [less than one hour] loss of consciousness Other closed skull fracture with intracranial injury of other and unspecified nature, with loss 803.46 of consciousness of unspecified duration Other closed skull fracture with intracranial injury of other and unspecified nature, with 803.49 concussion, unspecified Closed fractures involving skull or face with other bones, without mention of intracranial 804.00 injury, unspecified state of consciousness Closed fractures involving skull or face with other bones, without mention of intracranial 804.01 injury, with no loss of consciousness Closed fractures involving skull or face with other bones, without mention of intracranial 804.02 injury, with brief [less than one hour] loss of consciousness Closed fractures involving skull or face with other bones, without mention of intracranial 804.03 injury, with moderate [1-24 hours] loss of consciousness Closed fractures involving skull of face with other bones, without mention of intracranial 804.06 injury, with loss of consciousness of unspecified duration Closed fractures involving skull of face with other bones, without mention of intracranial 804.09 injury, with concussion, unspecified Closed fractures involving skull or face with other bones, with cerebral laceration and 804.10 contusion, unspecified state of consciousness Closed fractures involving skull or face with other bones, with cerebral laceration and 804.11 contusion, with no loss of consciousness Closed fractures involving skull or face with other bones, with cerebral laceration and 804.12 contusion, with brief [less than one hour] loss of consciousness Closed fractures involving skull or face with other bones, with cerebral laceration and 804.13 contusion, with moderate [1-24 hours] loss of consciousness Closed fractures involving skull or face with other bones, with cerebral laceration and 804.16 contusion, with loss of consciousness of unspecified duration Closed fractures involving skull or face with other bones, with cerebral laceration and 804.19 contusion, with concussion, unspecified 804.20 Closed fractures involving skull or face with other bones with subarachnoid, subdural, and

American College of Emergency Physicians Claims Specifications extradural hemorrhage, unspecified state of consciousness Closed fractures involving skull or face with other bones with subarachnoid, subdural, and 804.21 extradural hemorrhage, with no loss of consciousness Closed fractures involving skull or face with other bones with subarachnoid, subdural, and 804.22 extradural hemorrhage, with brief [less than one hour] loss of consciousness Closed fractures involving skull or face with other bones with subarachnoid, subdural, and 804.23 extradural hemorrhage, with moderate [1-24 hours] loss of consciousness Closed fractures involving skull or face with other bones with subarachnoid, subdural, and 804.26 extradural hemorrhage, with loss of consciousness of unspecified duration Closed fractures involving skull or face with other bones with subarachnoid, subdural, and 804.29 extradural hemorrhage, with concussion, unspecified Closed fractures involving skull or face with other bones, with other and unspecified 804.30 intracranial hemorrhage, unspecified state of consciousness Closed fractures involving skull or face with other bones, with other and unspecified 804.31 intracranial hemorrhage, with no loss of consciousness Closed fractures involving skull or face with other bones, with other and unspecified 804.32 intracranial hemorrhage, with brief [less than one hour] loss of consciousness Closed fractures involving skull or face with other bones, with other and unspecified 804.33 intracranial hemorrhage, with moderate [1-24 hours] loss of consciousness Closed fractures involving skull or face with other bones, with other and unspecified 804.36 intracranial hemorrhage, with loss of consciousness of unspecified duration Closed fractures involving skull or face with other bones, with other and unspecified 804.39 intracranial hemorrhage, with concussion, unspecified Closed fractures involving skull or face with other bones, with intracranial injury of other and 804.40 unspecified nature, unspecified state of consciousness Closed fractures involving skull or face with other bones, with intracranial injury of other and 804.41 unspecified nature, with no loss of consciousness Closed fractures involving skull or face with other bones, with intracranial injury of other and 804.42 unspecified nature, with brief [less than one hour] loss of consciousness Closed fractures involving skull or face with other bones, with intracranial injury of other and 804.43 unspecified nature, with moderate [1-24 hours] loss of consciousness Closed fractures involving skull or face with other bones, with intracranial injury of other and 804.46 unspecified nature, with loss of consciousness of unspecified duration Closed fractures involving skull or face with other bones, with intracranial injury of other and 804.49 unspecified nature, with concussion, unspecified 850.0 Concussion with no loss of consciousness 850.11 Concussion, with loss of consciousness of 30 minutes or less 850.12 Concussion, with loss of consciousness from 31 to 59 minutes 850.2 Concussion with moderate loss of consciousness 850.5 Concussion with loss of consciousness of unspecified duration 850.9 Concussion, unspecified Cortex (cerebral) contusion without mention of open intracranial wound, unspecified state of 851.00 consciousness Cortex (cerebral) contusion without mention of open intracranial wound, with no loss of 851.01 consciousness Cortex (cerebral) contusion without mention of open intracranial wound, with brief [less than 851.02 one hour] loss of consciousness Cortex (cerebral) contusion without mention of open intracranial wound, with moderate [1-24 851.03 hours] loss of consciousness Cortex (cerebral) contusion without mention of open intracranial wound, with loss of 851.06 consciousness of unspecified duration Cortex (cerebral) contusion without mention of open intracranial wound, with concussion, 851.09 unspecified Cortex (cerebral) laceration without mention of open intracranial wound, unspecified state of 851.20 consciousness Cortex (cerebral) laceration without mention of open intracranial wound, with no loss of 851.21 consciousness Cortex (cerebral) laceration without mention of open intracranial wound, with brief [less than 851.22 one hour] loss of consciousness

American College of Emergency Physicians Claims Specifications Cortex (cerebral) laceration without mention of open intracranial wound, with moderate [1-24 851.23 hours] loss of consciousness Cortex (cerebral) laceration without mention of open intracranial wound, with loss of 851.26 consciousness of unspecified duration Cortex (cerebral) laceration without mention of open intracranial wound, with concussion, 851.29 unspecified Cerebellar or brain stem contusion without mention of open intracranial wound, unspecified 851.40 state of consciousness Cerebellar or brain stem contusion without mention of open intracranial wound, with no loss 851.41 of consciousness Cerebellar or brain stem contusion without mention of open intracranial wound, with brief 851.42 [less than one hour] loss of consciousness Cerebellar or brain stem contusion without mention of open intracranial wound, with 851.43 moderate [1-24 hours] loss of consciousness Cerebellar or brain stem contusion without mention of open intracranial wound, with loss of 851.46 consciousness of unspecified duration Cerebellar or brain stem contusion without mention of open intracranial wound, with 851.49 concussion, unspecified Cerebellar or brain stem laceration without mention of open intracranial wound, unspecified 851.60 state of consciousness Cerebellar or brain stem laceration without mention of open intracranial wound, with no loss 851.61 of consciousness Cerebellar or brain stem laceration without mention of open intracranial wound, with brief 851.62 [less than 1 hour] loss of consciousness Cerebellar or brain stem laceration without mention of open intracranial wound, with 851.63 moderate [1-24 hours] loss of consciousness Cerebellar or brain stem laceration without mention of open intracranial wound, with loss of 851.66 consciousness of unspecified duration Cerebellar or brain stem laceration without mention of open intracranial wound, with 851.69 concussion, unspecified Other and unspecified cerebral laceration and contusion, without mention of open intracranial 851.80 wound, unspecified state of consciousness Other and unspecified cerebral laceration and contusion, without mention of open intracranial 851.81 wound, with no loss of consciousness Other and unspecified cerebral laceration and contusion, without mention of open intracranial 851.82 wound, with brief [less than one hour] loss of consciousness Other and unspecified cerebral laceration and contusion, without mention of open intracranial 851.83 wound, with moderate [1-24 hours] loss of consciousness Other and unspecified cerebral laceration and contusion, without mention of open intracranial 851.86 wound, with loss of consciousness of unspecified duration Other and unspecified cerebral laceration and contusion, without mention of open intracranial 851.89 wound, with concussion, unspecified Subarachnoid hemorrhage following injury without mention of open intracranial wound, 852.00 unspecified state of consciousness Subarachnoid hemorrhage following injury without mention of open intracranial wound, with 852.01 no loss of consciousness Subarachnoid hemorrhage following injury without mention of open intracranial wound, with 852.02 brief [less than one hour] loss of consciousness Subarachnoid hemorrhage following injury without mention of open intracranial wound, with 852.03 moderate [1-24 hours] loss of consciousness Subarachnoid hemorrhage following injury without mention of open intracranial wound, with 852.06 loss of consciousness of unspecified duration Subarachnoid hemorrhage following injury without mention of open intracranial wound, with 852.09 concussion, unspecified Subdural hemorrhage following injury without mention of open intracranial wound, 852.20 unspecified state of consciousness Subdural hemorrhage following injury without mention of open intracranial wound, with no 852.21 loss of consciousness Subdural hemorrhage following injury without mention of open intracranial wound, with brief 852.22 [less than one hour] loss of consciousness 852.23 Subdural hemorrhage following injury without mention of open intracranial wound, with

American College of Emergency Physicians Claims Specifications moderate [1-24 hours] loss of consciousness Subdural hemorrhage following injury without mention of open intracranial wound, with loss 852.26 of consciousness of unspecified duration Subdural hemorrhage following injury without mention of open intracranial wound, with 852.29 concussion, unspecified Extradural hemorrhage following injury without mention of open intracranial wound, 852.40 unspecified state of consciousness Extradural hemorrhage following injury without mention of open intracranial wound, with no 852.41 loss of consciousness Extradural hemorrhage following injury without mention of open intracranial wound, with 852.42 brief [less than 1 hour] loss of consciousness Extradural hemorrhage following injury without mention of open intracranial wound, with 852.43 moderate [1-24 hours] loss of consciousness Extradural hemorrhage following injury without mention of open intracranial wound, with loss 852.46 of consciousness of unspecified duration Extradural hemorrhage following injury without mention of open intracranial wound, with 852.49 concussion, unspecified Other and unspecified intracranial hemorrhage following injury without mention of open 853.00 intracranial wound, unspecified state of consciousness Other and unspecified intracranial hemorrhage following injury without mention of open 853.01 intracranial wound, with no loss of consciousness Other and unspecified intracranial hemorrhage following injury without mention of open 853.02 intracranial wound, with brief [less than one hour] loss of consciousness Other and unspecified intracranial hemorrhage following injury without mention of open 853.03 intracranial wound, with moderate [1-24 hours] loss of consciousness Other and unspecified intracranial hemorrhage following injury without mention of open 853.06 intracranial wound, with loss of consciousness of unspecified duration Other and unspecified intracranial hemorrhage following injury without mention of open 853.09 intracranial wound, with concussion, unspecified Intracranial injury of other and unspecified nature without mention of open intracranial 854.00 wound, unspecified state of consciousness Intracranial injury of other and unspecified nature without mention of open intracranial 854.01 wound, with no loss of consciousness Intracranial injury of other and unspecified nature without mention of open intracranial 854.02 wound, with brief [less than one hour] loss of consciousness Intracranial injury of other and unspecified nature without mention of open intracranial 854.03 wound, with moderate [1-24 hours] loss of consciousness Intracranial injury of other and unspecified nature without mention of open intracranial 854.06 wound, with loss of consciousness of unspecified duration Intracranial injury of other and unspecified nature without mention of open intracranial 854.09 wound, with concussion, unspecified 920 Contusion of face, scalp, and neck except eye(s) 959.01 Head injury, unspecified

ICD-10-CM Diagnosis Code for non-penetrating head injury (reportable beginning 10/1/2015): Code Descriptor S00.03XA Contusion of scalp, initial encounter S00.33XA Contusion of nose, initial encounter S00.431A Contusion of right ear, initial encounter S00.432A Contusion of left ear, initial encounter S00.439A Contusion of unspecified ear, initial encounter S00.531A Contusion of lip, initial encounter S00.532A Contusion of oral cavity, initial encounter S00.83XA Contusion of other part of head, initial encounter S00.93XA Contusion of unspecified part of head, initial encounter S02.0XXA Fracture of vault of skull, initial encounter for closed fracture S02.10XA Unspecified fracture of base of skull, initial encounter for closed fracture

American College of Emergency Physicians Claims Specifications

S02.110A Type I occipital condyle fracture, initial encounter for closed fracture S02.111A Type II occipital condyle fracture, initial encounter for closed fracture S02.112A Type III occipital condyle fracture, initial encounter for closed fracture S02.113A Unspecified occipital condyle fracture, initial encounter for closed fracture S02.118A Other fracture of occiput, initial encounter for closed fracture S02.119A Unspecified fracture of occiput, initial encounter for closed fracture S02.19XA Other fracture of base of skull, initial encounter for closed fracture S02.2XXA Fracture of nasal bones, initial encounter for closed fracture S02.3XXA Fracture of orbital floor, initial encounter for closed fracture S02.400A Malar fracture unspecified, initial encounter for closed fracture S02.401A Maxillary fracture, unspecified, initial encounter for closed fracture S02.402A Zygomatic fracture, unspecified, initial encounter for closed fracture S02.411A LeFort I fracture, initial encounter for closed fracture S02.412A LeFort II fracture, initial encounter for closed fracture S02.413A LeFort III fracture, initial encounter for closed fracture S02.42XA Fracture of alveolus of maxilla, initial encounter for closed fracture S02.600A Fracture of unspecified part of body of mandible, initial encounter for closed fracture S02.609A Fracture of mandible, unspecified, initial encounter for closed fracture S02.61XA Fracture of condylar process of mandible, initial encounter for closed fracture S02.62XA Fracture of subcondylar process of mandible, initial encounter for closed fracture S02.63XA Fracture of coronoid process of mandible, initial encounter for closed fracture S02.64XA Fracture of ramus of mandible, initial encounter for closed fracture S02.65XA Fracture of angle of mandible, initial encounter for closed fracture S02.66XA Fracture of symphysis of mandible, initial encounter for closed fracture S02.67XA Fracture of alveolus of mandible, initial encounter for closed fracture S02.69XA Fracture of mandible of other specified site, initial encounter for closed fracture S02.8XXA Fractures of other specified skull and facial bones, initial encounter for closed fracture S02.91XA Unspecified fracture of skull, initial encounter for closed fracture S02.92XA Unspecified fracture of facial bones, initial encounter for closed fracture S06.0X0A Concussion without loss of consciousness, initial encounter S06.0X1A Concussion with loss of consciousness of 30 minutes or less, initial encounter S06.0X2A Concussion with loss of consciousness of 31 minutes to 59 minutes, initial encounter S06.0X3A Concussion with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter S06.0X4A Concussion with loss of consciousness of 6 hours to 24 hours, initial encounter S06.0X9A Concussion with loss of consciousness of unspecified duration, initial encounter S06.1X0A Traumatic cerebral edema without loss of consciousness, initial encounter S06.1X1A Traumatic cerebral edema with loss of consciousness of 30 minutes or less, initial encounter Traumatic cerebral edema with loss of consciousness of 31 minutes to 59 minutes, initial S06.1X2A encounter Traumatic cerebral edema with loss of consciousness of 1 hour to 5 hours 59 minutes, initial S06.1X3A encounter Traumatic cerebral edema with loss of consciousness of 6 hours to 24 hours, initial S06.1X4A encounter Traumatic cerebral edema with loss of consciousness of unspecified duration, initial S06.1X9A encounter S06.2X0A Diffuse traumatic brain injury without loss of consciousness, initial encounter Diffuse traumatic brain injury with loss of consciousness of 30 minutes or less, initial S06.2X1A encounter Diffuse traumatic brain injury with loss of consciousness of 31 minutes to 59 minutes, initial S06.2X2A encounter Diffuse traumatic brain injury with loss of consciousness of 1 hour to 5 hours 59 minutes, S06.2X3A initial encounter

American College of Emergency Physicians Claims Specifications Diffuse traumatic brain injury with loss of consciousness of 6 hours to 24 hours, initial S06.2X4A encounter Diffuse traumatic brain injury with loss of consciousness of unspecified duration, initial S06.2X9A encounter S06.300A Unspecified focal traumatic brain injury without loss of consciousness, initial encounter Unspecified focal traumatic brain injury with loss of consciousness of 30 minutes or less, S06.301A initial encounter Unspecified focal traumatic brain injury with loss of consciousness of 31 minutes to 59 S06.302A minutes, initial encounter Unspecified focal traumatic brain injury with loss of consciousness of 1 hour to 5 hours 59 S06.303A minutes, initial encounter Unspecified focal traumatic brain injury with loss of consciousness of 6 hours to 24 hours, S06.304A initial encounter Unspecified focal traumatic brain injury with loss of consciousness of unspecified duration, S06.309A initial encounter S06.310A Contusion and laceration of right cerebrum without loss of consciousness, initial encounter Contusion and laceration of right cerebrum with loss of consciousness of 30 minutes or less, S06.311A initial encounter Contusion and laceration of right cerebrum with loss of consciousness of 31 minutes to 59 S06.312A minutes, initial encounter Contusion and laceration of right cerebrum with loss of consciousness of 1 hour to 5 hours S06.313A 59 minutes, initial encounter Contusion and laceration of right cerebrum with loss of consciousness of 6 hours to 24 S06.314A hours, initial encounter Contusion and laceration of right cerebrum with loss of consciousness of unspecified S06.319A duration, initial encounter S06.320A Contusion and laceration of left cerebrum without loss of consciousness, initial encounter Contusion and laceration of left cerebrum with loss of consciousness of 30 minutes or less, S06.321A initial encounter Contusion and laceration of left cerebrum with loss of consciousness of 31 minutes to 59 S06.322A minutes, initial encounter Contusion and laceration of left cerebrum with loss of consciousness of 1 hour to 5 hours 59 S06.323A minutes, initial encounter Contusion and laceration of left cerebrum with loss of consciousness of 6 hours to 24 hours, S06.324A initial encounter Contusion and laceration of left cerebrum with loss of consciousness of unspecified S06.329A duration, initial encounter Contusion and laceration of cerebrum, unspecified, without loss of consciousness, initial S06.330A encounter Contusion and laceration of cerebrum, unspecified, with loss of consciousness of 30 minutes S06.331A or less, initial encounter Contusion and laceration of cerebrum, unspecified, with loss of consciousness of 31 minutes S06.332A to 59 minutes, initial encounter Contusion and laceration of cerebrum, unspecified, with loss of consciousness of 1 hour to 5 S06.333A hours 59 minutes, initial encounter Contusion and laceration of cerebrum, unspecified, with loss of consciousness of 6 hours to S06.334A 24 hours, initial encounter Contusion and laceration of cerebrum, unspecified, with loss of consciousness of unspecified S06.339A duration, initial encounter S06.340A Traumatic hemorrhage of right cerebrum without loss of consciousness, initial encounter Traumatic hemorrhage of right cerebrum with loss of consciousness of 30 minutes or less, S06.341A initial encounter Traumatic hemorrhage of right cerebrum with loss of consciousness of 31 minutes to 59 S06.342A minutes, initial encounter Traumatic hemorrhage of right cerebrum with loss of consciousness of 1 hours to 5 hours S06.343A 59 minutes, initial encounter Traumatic hemorrhage of right cerebrum with loss of consciousness of 6 hours to 24 hours, S06.344A initial encounter Traumatic hemorrhage of right cerebrum with loss of consciousness of unspecified duration, S06.349A initial encounter

American College of Emergency Physicians Claims Specifications

S06.350A Traumatic hemorrhage of left cerebrum without loss of consciousness, initial encounter Traumatic hemorrhage of left cerebrum with loss of consciousness of 30 minutes or less, S06.351A initial encounter Traumatic hemorrhage of left cerebrum with loss of consciousness of 31 minutes to 59 S06.352A minutes, initial encounter Traumatic hemorrhage of left cerebrum with loss of consciousness of 1 hours to 5 hours 59 S06.353A minutes, initial encounter Traumatic hemorrhage of left cerebrum with loss of consciousness of 6 hours to 24 hours, S06.354A initial encounter Traumatic hemorrhage of left cerebrum with loss of consciousness of unspecified duration, S06.359A initial encounter Traumatic hemorrhage of cerebrum, unspecified, without loss of consciousness, initial S06.360A encounter Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of 30 minutes S06.361A or less, initial encounter Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of 31 minutes S06.362A to 59 minutes, initial encounter Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of 1 hours to 5 S06.363A hours 59 minutes, initial encounter Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of 6 hours to 24 S06.364A hours, initial encounter Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of unspecified S06.369A duration, initial encounter Contusion, laceration, and hemorrhage of cerebellum without loss of consciousness, initial S06.370A encounter Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness of 30 S06.371A minutes or less, initial encounter Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness of 31 S06.372A minutes to 59 minutes, initial encounter Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness of 1 hour to S06.373A 5 hours 59 minutes, initial encounter Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness of 6 hours S06.374A to 24 hours, initial encounter Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness of S06.379A unspecified duration, initial encounter Contusion, laceration, and hemorrhage of brainstem without loss of consciousness, initial S06.380A encounter Contusion, laceration, and hemorrhage of brainstem with loss of consciousness of 30 S06.381A minutes or less, initial encounter Contusion, laceration, and hemorrhage of brainstem with loss of consciousness of 31 S06.382A minutes to 59 minutes, initial encounter Contusion, laceration, and hemorrhage of brainstem with loss of consciousness of 1 hour to S06.383A 5 hours 59 minutes, initial encounter Contusion, laceration, and hemorrhage of brainstem with loss of consciousness of 6 hours to S06.384A 24 hours, initial encounter Contusion, laceration, and hemorrhage of brainstem with loss of consciousness of S06.389A unspecified duration, initial encounter S06.4X0A Epidural hemorrhage without loss of consciousness, initial encounter S06.4X1A Epidural hemorrhage with loss of consciousness of 30 minutes or less, initial encounter Epidural hemorrhage with loss of consciousness of 31 minutes to 59 minutes, initial S06.4X2A encounter Epidural hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, initial S06.4X3A encounter S06.4X4A Epidural hemorrhage with loss of consciousness of 6 hours to 24 hours, initial encounter S06.4X9A Epidural hemorrhage with loss of consciousness of unspecified duration, initial encounter S06.5X0A Traumatic subdural hemorrhage without loss of consciousness, initial encounter Traumatic subdural hemorrhage with loss of consciousness of 30 minutes or less, initial S06.5X1A encounter S06.5X2A Traumatic subdural hemorrhage with loss of consciousness of 31 minutes to 59 minutes,

American College of Emergency Physicians Claims Specifications initial encounter Traumatic subdural hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, S06.5X3A initial encounter Traumatic subdural hemorrhage with loss of consciousness of 6 hours to 24 hours, initial S06.5X4A encounter Traumatic subdural hemorrhage with loss of consciousness of unspecified duration, initial S06.5X9A encounter S06.6X0A Traumatic subarachnoid hemorrhage without loss of consciousness, initial encounter Traumatic subarachnoid hemorrhage with loss of consciousness of 30 minutes or less, initial S06.6X1A encounter Traumatic subarachnoid hemorrhage with loss of consciousness of 31 minutes to 59 S06.6X2A minutes, initial encounter Traumatic subarachnoid hemorrhage with loss of consciousness of 1 hour to 5 hours 59 S06.6X3A minutes, initial encounter Traumatic subarachnoid hemorrhage with loss of consciousness of 6 hours to 24 hours, S06.6X4A initial encounter Traumatic subarachnoid hemorrhage with loss of consciousness of unspecified duration, S06.6X9A initial encounter Injury of right internal carotid artery, intracranial portion, not elsewhere classified without S06.810A loss of consciousness, initial encounter Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss S06.811A of consciousness of 30 minutes or less, initial encounter Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss S06.812A of consciousness of 31 minutes to 59 minutes, initial encounter Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss S06.813A of consciousness of 1 hour to 5 hours 59 minutes, initial encounter Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss S06.814A of consciousness of 6 hours to 24 hours, initial encounter Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss S06.819A of consciousness of unspecified duration, initial encounter Injury of left internal carotid artery, intracranial portion, not elsewhere classified without S06.820A loss of consciousness, initial encounter Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of S06.821A consciousness of 30 minutes or less, initial encounter Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of S06.822A consciousness of 31 minutes to 59 minutes, initial encounter Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of S06.823A consciousness of 1 hour to 5 hours 59 minutes, initial encounter Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of S06.824A consciousness of 6 hours to 24 hours, initial encounter Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of S06.829A consciousness of unspecified duration, initial encounter S06.890A Other specified intracranial injury without loss of consciousness, initial encounter Other specified intracranial injury with loss of consciousness of 30 minutes or less, initial S06.891A encounter Other specified intracranial injury with loss of consciousness of 31 minutes to 59 minutes, S06.892A initial encounter Other specified intracranial injury with loss of consciousness of 1 hour to 5 hours 59 S06.893A minutes, initial encounter Other specified intracranial injury with loss of consciousness of 6 hours to 24 hours, initial S06.894A encounter Other specified intracranial injury with loss of consciousness of unspecified duration, initial S06.899A encounter S06.9X0A Unspecified intracranial injury without loss of consciousness, initial encounter Unspecified intracranial injury with loss of consciousness of 30 minutes or less, initial S06.9X1A encounter Unspecified intracranial injury with loss of consciousness of 31 minutes to 59 minutes, S06.9X2A initial encounter Unspecified intracranial injury with loss of consciousness of 1 hour to 5 hours 59 minutes, S06.9X3A initial encounter

American College of Emergency Physicians Claims Specifications Unspecified intracranial injury with loss of consciousness of 6 hours to 24 hours, initial S06.9X4A encounter Unspecified intracranial injury with loss of consciousness of unspecified duration, initial S06.9X9A encounter S09.10XA Unspecified injury of muscle and tendon of head, initial encounter S09.11XA Strain of muscle and tendon of head, initial encounter S09.19XA Other specified injury of muscle and tendon of head, initial encounter S09.8XXA Other specified injuries of head, initial encounter S09.90XA Unspecified injury of head, initial encounter S09.92XA Unspecified injury of nose, initial encounter S09.93XA Unspecified injury of face, initial encounter S10.0XXA Contusion of throat, initial encounter S10.83XA Contusion of other specified part of neck, initial encounter S10.93XA Contusion of unspecified part of neck, initial encounter

AND GXXXX: Patient presented within 24 hours of a minor blunt head trauma with a GCS score of 15 and had a head CT ordered for trauma*

*To determine whether or not an emergency department physician ordered a head CT, look for CPT code 70450.

Patients with any of the following:  Ventricular shunt  Brain tumor  Multisystem trauma  Pregnancy  Currently taking any of the following antiplatelet medications: Denominator o ASA/dipyridamole Exclusions o clopidogrel o prasugrel o ticlopidine

To report patient having met denominator exclusion criteria, report:  GXXX2: Patient meets denominator exclusion criteria (ie, ventricular shunt, brain tumor, multisystem trauma, pregnancy, or currently taking an antiplatelet medication)

American College of Emergency Physicians Claims Specifications Numerator Denominator emergency department visits for patients who have an indication for a head CT

Indications for a head CT in patients presenting to the emergency department for minor blunt head trauma:

Patients with any of the following:  Severe headache  Vomiting  Age 65 years and older  Physical signs of basilar skull fracture (signs include haemotympanum, “panda” eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign)  Focal neurological deficit  Coagulopathy  Thrombocytopenia  Currently taking any of the following anticoagulant medications: apixaban, argatroban, bivalirudin, dabigatran, dalteparin, desirudin, enoxaparinm, fondaparinux, heparin, lepirudin, low molecular weight heparin, rivaroxaban, tinzaparin, warfarin  Dangerous Mechanism (ie, ejection from a motor vehicle, a pedestrian struck, and a fall from a height of more than 3 feet or 5 stairs)

Patients with either loss of consciousness OR posttraumatic amnesia AND any one of the following:  Headache  Age 60 years and older, and less than 65 years  Drug/alcohol intoxication  Short-term memory deficits  Evidence of trauma above the clavicles (physical location, any trauma to the head or neck [ie, laceration, abrasion, bruising, ecchymosis, hematoma, swelling, fracture])  Posttraumatic seizure

Quality Data Code for a data element in this numerator : GXXX3: Patient with minor blunt head trauma had an indication for a head CT

Denominator None Exceptions

Additional Quality Data If the patient’s head injury occurred greater than 24 hours before presentation to the emergency Codes used department, has a GCS score less than 15, or did not have a head CT ordered for minor blunt to report head trauma, report GXXX1. this measure

Reporting Instructions To be drafted once measure is static.