What ICD‑10 code should I use for a self‑inflicted open wound of the fingers where the patient peeled off the skin?

ICD-10 Coding for Self-Inflicted Skin Peeling of Fingers

For a patient who intentionally peeled skin off her own fingers, you should use a combination of two codes: an injury code for the open wound (S61.4XX series for the specific finger involved) plus an external cause code X78.9 (intentional self-harm by sharp object, unspecified) or T14.91 (suicide attempt) if the mechanism is unknown.

Primary Injury Code Selection

• Code the anatomic injury first using S61.4XX series (open wound of finger without damage to nail) with the appropriate 7th character "A" for initial encounter 1, 2.
• Specify the exact finger(s) involved using the appropriate digit identifier in the code 1.
• If multiple fingers are involved, code each finger separately 1.

External Cause of Injury Code

You must add an external cause code to indicate intentional self-harm:

• Use X78.9 (intentional self-harm by sharp object, unspecified) if the patient used fingernails or any sharp implement to peel the skin 1, 2.
• Alternatively, use T14.91 (suicide attempt) only if the specific mechanism of self-harm is completely unknown or undocumented, though coding guidelines restrict this code's use 1, 2.
• The external cause code (X71-X83 series) is essential for surveillance of intentional self-harm and should always be included when intent is documented 3, 1.

Documentation Requirements

• Ensure provider documentation clearly states "intentional" or "self-inflicted" to support the use of external cause codes indicating intentional self-harm 4, 2.
• Document any psychiatric diagnoses present (depression, personality disorder, psychotic disorder, adjustment reaction) as these support the intentional self-harm diagnosis and may require additional coding 4.
• The positive predictive value for capturing intentional self-harm with proper ICD-10-CM coding is approximately 89% when documentation is clear 2.

Common Coding Pitfalls

• Do not use undetermined intent codes (Y28-Y29) unless the medical record explicitly documents that intent cannot be determined 1.
• Avoid using only the injury code without the external cause code, as this loses critical surveillance data about intentional self-harm 3, 1.
• The T14.91 code alone captures very few cases (only 7 out of 207 in one study) because its use is restricted to unknown mechanisms 2.
• Always code to the highest level of specificity available in the medical record regarding which finger(s) were injured 1.

Additional Considerations

• If there is documented suicidal intent or suicide ideation, ensure this is captured in both the medical record and through appropriate psychiatric diagnosis codes, as approximately 46% of intentional self-harm injuries involve intent to die 2.
• Consider adding codes for any underlying psychiatric conditions that may have contributed to the self-harm behavior 4.