Introduction

Once you have collected and reconciled the ED records, the next step is to extract and code the relevant surveillance data. There are 16 NEISS data variables. They are:

Each data variable has a set of associated codes used to describe the specific circumstances of an ED case. Data variables also have associated coding rules to help you select the proper codes for each case.

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Introduction - The Coding Sheet

The NEISS coding sheet gives you a convenient way to code surveillance data for each ED case prior to entering it into the NEISS computer. The coding sheet organizes and presents the surveillance data variables in the order in which they are entered into the NEISS computer. The coding sheet has space enough to code several cases.

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Coding Treatment Date

Code the date on which the patient was seen for treatment. Treatment date is coded in the format MM/DD/YYYY with a zero added to days and months that are one digit numbers.

For example:

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Coding Case Number

Each case treated on a specific date must have a unique number of up to 8 digits.

• If your hospital uses more than eight digits for its case numbers, code only the last eight digits.
• Do not code any letters of the alphabet which may appear in your hospital's case number. Instead, substitute zeros for any letters.

  For example:
  

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Coding Age

PC-NEISS will automatically calculate and insert the age of a patient if you enter the date of birth. If the date of birth is not available, the age of the patient must be entered.

• For a patient two years of age or older, record age in years.

• For a patient under two years of age, code the age in months and put a “2” in the first block of the age field.

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Coding Gender

Indicate the gender of the patient with one of the codes listed below:

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Coding Diagnosis

The two (2) digit diagnosis codes are listed in Appendix B and D of the NEISS Coding Manual located in the course Tool Kit. For coding purposes, always use the most specific diagnosis/diagnostic information provided by medical personnel. If specific information is not available, review the patient’s complaint and the treatment given to arrive at the most logical diagnosis.

Other considerations for coding diagnosis are:

• When more than one diagnosis appears on the emergency department record, code the one that seems to be the most severe and note the other diagnoses in the “Comment” field.
• If diagnosis code 71 (Other/Not stated) is entered, the cursor automatically tabs to the “Diagnosis Other” text field. You are required to enter a text string in this field to describe the “other” diagnosis.
• If diagnosis states R/O (Rule out), code this as the diagnosis only if there is no other specific diagnosis to code.
• If there is a poisoning or chemical burn to a child under 5 years old from a product which is not listed in the coding manual, or if the product code is underlined, use code 5555.

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Coding Diagnosis - Burns

There are several types of burns and associated codes. If the attending physician's diagnosis is inadequate, one can sometimes deduce the type of burn from the kind of incident and product(s) involved.

* For thermal burns, indicate in the “Comment” field if the burn came from flame or hot surface.

 

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Coding Diagnosis - Poisoning

Code 68 (Poisoning) should be used when a patient:

• Swallowed either a liquid or soluble chemical or drug/medication.
  

Exception: Poisoning associated only with drugs, cosmetics, or pesticides are out-of-scope except if the victim is under age 5.


• Inhaled vapors, fumes or gases; e.g.., from chemicals, cleaners or fuels.
  

Exception: For inhaled vapors from carbon monoxide (CO) and smoke
from fires use code 65 (Anoxia).


• Swallowed either a liquid or soluble chemical or drug and had an “allergic reaction”; e.g.., including swelling, skin rashes, etc.

When diagnosis code 68 (Poisoning) is used, always use body part code 85 (All parts of body).

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Coding Diagnosis - Anoxia

Code 65 (Anoxia) should be used when the patient cannot obtain sufficient oxygen, either due to hampered breathing or lack of oxygen itself.

Code anoxia when:

• The diagnosis is strangulation, suffocation or asphyxia.
• The patient has inhaled products of combustion, such as carbon monoxide (CO), smoke, soot, etc. (e.g., from a house fire, heating appliance, or camping equipment).

When you use diagnosis code 65 (Anoxia), you should also used the body part code 85 (All parts of body).

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Coding Diagnosis - Ingested Foreign Object

Code 41 (Ingested foreign object) must only be used when both of the following conditions are met:

• The patient has swallowed an insoluble, solid object; i.e., an item that will not dissolve in liquid.
• The swallowed object is not likely to cause poisoning.

When you use diagnosis code 41 (Ingested foreign object), you should also use the body part code 00 (Internal).

Some commonly swallowed objects are coins, toy parts, buttons, nails, crayons. The foreign object may or may not have lodged somewhere inside the body.

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Coding Diagnosis - Aspirated Foreign Objects

Code 42 (Aspirated foreign object) should be used when an object causes choking or is caught in the nose, lungs, or airway in between the nose and the lungs, and should generally be one that does not lead to poisoning or anoxia (inability to obtain oxygen). Examples of such objects are thumbtacks, beads, miniature light bulbs, and even pills.

If the victim chokes while being fed liquids and the hospital record describes the event as an aspiration, then the aspiration code may be used.

When you use diagnosis code 42 (Aspirated foreign object), you should also use body part code 00 (Internal).

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Coding Diagnosis - Other / Not Stated

Code 71 (Other/not stated) is used if none of the listed diagnoses in the NEISS Coding Manual are appropriate. Whenever you use diagnosis code 71 (Other/not stated), the PC-NEISS software requires that the actual diagnosis, if stated in the ED record, be noted in the “Diagnosis Other” text field. If the diagnosis is not stated, enter “unknown” in the “Diagnosis Other” text field.

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Coding Body Parts

The two (2) digit body part code is used to locate an injury on the patient’s body. See the NEISS Coding Manual, Appendix C in the course Tool Kit for a list of the body part codes. The body part diagram in Appendix D will also help you visualize more clearly the boundaries between body parts.

In general, if an injury affects more than one body part, code the body part that seems to be most seriously hurt. Then, mention other affected body parts in the “Comment” text field.

Use body part code 84 (25%-50% of body) when a burn injury scenario specifically states that 25-50% of the body was burned, or when the record states that multiple body parts are involved but does not identify any specific body part.

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Coding Body Parts - Special Injuries

Back Injuries

For a diagnosed back injury, determine if the upper trunk, lower trunk, or cervical vertebrae was/were involved:

• Use the waist or navel as the dividing line to differentiate between upper and lower trunk.
• Use code 31 (Upper trunk/Thoracic vertebrae) for upper back involvement.
• Use code 79 (Lower trunk/Lumbar vertebrae) for lower back involvement.
• Use code 89 (Neck) for cervical vertebrae involvement.

Burn Injuries

• If only one body part was injured, code that body part. If more than one body part was injured, generally code the body part with the most severe injury.
• For burns involving up to 25% of the body, code the most severely burned body part.
• For burns covering 25% to 50% of the body, use code 84.
• For burns covering more than 50% of the body surface, use code 85.

Eye Injuries

• For injuries to eyelids, eyebrows, or the area immediately around the eyes, use code 76 (Face).
• For an injury to the eye itself, use code 77 (Eyeball).

Head Injuries

• When coding head injuries, code the most specific diagnosis given.
• Code 62 (Internal organ) when there is no specific diagnosis for a head injury.
• Coding the most specific diagnosis should not take precedence over coding the most severe injury. For example, for internal head injuries such as subdural hematoma, hemorrhaging, etc., use code 62 (Internal organ).
• Code 58 (Hematoma) if the diagnosis only states “hematoma to the head.”
• When there are two injuries even to the head, code the most severe.

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Coding Disposition

Use the codes listed below to indicate the disposition of a case:

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Coding Products

There are two coding fields for products, “First Product” and “Second Product.” Use these fields to code the consumer product(s) associated with an illness or injury. All product codes are listed alphabetically in the NEISS Coding Manual in the course Tool Kit.

Here are some general guidelines to follow when coding products:

• When only one product is associated with an injury, enter the code for that product in the “First Product” field and fill in the “Second Product” field with four zeros (0000).
  
• Whenever possible, report specific products rather than general types of products. For example, code hand saw and gas oven vs. saw and oven.
  
• Use the “other” product codes, as in “Other baby carriers,” only when the ED record identifies a specific product but there is no code given for that particular product.

Consult the NEISS Coding Manual for a detailed discussion of product coding.

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Coding Products - Two Product Injuries

When two products are associated with an injury, either product may be coded as the first product and the other as the second product.

Example: An 11-year old boy riding a bicycle ran into a swing

Product 1 = code 5040 (Bicycle) and Product 2 = code 3246 (Swings) or

Product 1 = code 3246 (Swings) and Product 2 = code 5040 (Bicycle)

Exception:

When two products involved in an incident are the same product, do not code a second product; simply fill in the “Second Product” field with zeros. For example, if two skateboard riders collide, code 1333 (Skateboard) for “First Product” and code 0000 for “Second Product.”

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Coding Products - Code 9999

Code 9999 is used if:

• You believe a case involves a consumer product, but you cannot determine an appropriate product code.
  
• You have a coding question about any case and are not able to discuss the case with your NEISS representative.

Headquarters staff will review these cases and determine whether a current NEISS product code can be used, or if a new product code should be added to the coding manual. In either case, your NEISS representative will contact you after reviewing the case.

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Coding Products - Special Incidents

Flammable Fabric

If a burn or smoke inhalation injury results directly from a flammable fabric, use the product codes for the source of the fire (e.g.., stove, portable room heater, camping lantern, etc.) and the first item to ignite (e.g.., blanket, clothing, draperies, slipcover, etc.).

In addition, you must enter the appropriate code 1, 2, or 3 in the “Fire” coding field to indicate that the incident involved smoke inhalation, unexpected flames or smoke, or unexpected spread of flames or smoke. (See the section on coding fire.)

House Fire

Code 1866 (General home or room involvement in fire) is used as the “First Product” code in the case of a house fire and/or smoke inhalation where no specific product is identified. Use this code, for example, when the emergency department record describes the incident as "house fire" or "fire in the basement" and no other information is available. No second product code (except 0000) can be used with this code.

If a specific consumer product is identified, code the specific product only - do not use product code 1866. Use code 1866 for First Product only when the record does not mention a product.

Also, whenever code 1866 is used:

• State the particular room involved, if known, in the “Comment” text field.
  
• Enter the appropriate code 1, 2, or 3 in the “Fire” coding field to indicate that the incident involved smoke inhalation, unexpected flames or smoke, or unexpected spread of flames or smoke. (See the section on coding fire.)

Product Fire

• Code the specific product(s) involved in a product fire. A product fire can be extensive; e.g., fire/flames or limited; e.g., with smoldering/smoke.
  
• Enter appropriate code 1, 2 or 3 in the “Fire” coding field to indicate that the incident involved smoke inhalation, unexpected flames or smoke, or unexpected spread of flames or smoke. (See the section on coding fire.)

Hot Water

Code 1934 (Hot water) is used for hot water injuries.

• When an injury involves hot water, code the source of the water (e.g.. tea kettle, sink, bathtub, etc.) as one product and use code 1934 (Hot water) as the other product code.
  
• If the source of the hot water is unknown, use code 1934 (Hot water) as the product.

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Coding Intent

Always use Code 0 (Unintentional, accidental, injury or intent not known or recorded) unless the case involves an intentional injury only if the victim and perpetrator are age 12 and under, or a firearm is involved.

Use the codes in the table below to indicate whether an injury resulted from a confirmed or suspected intentional act. An intentional injury or poisoning is one that is inflicted with the aim of injuring or killing. The injury may be either one that was inflicted by one person on another or one that was self-inflicted.

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Coding Intent - Assault / Intentional Injury

Code 1 (Assault/Intentional injury) includes all confirmed or suspected cases of injuries and poisonings inflicted by one person on another person only if the victim and perpetrator are age 12 and under, and the incident is product-related. Also includes any firearm incidents, regardless of age. This would include intended and unintended victims of violent acts.

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Coding Intent - Self Inflicted Injury

Code 2 (Self inflicted injury) includes suicides and suicide attempts, both confirmed and suspected, where the medical record indicates that the person was age 12 and under, and was trying to take their life, and a codeable consumer product is involved. Also includes any self-inflicted gunshot wounds, regardless of age.

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Coding Intent - Legal Intervention

Code 3 (Legal Intervention) includes injuries caused by police or other legal authorities during law enforcement activities where a firearm is involved.

Includes:

• Burglar shot by police.

Excludes:

• Police injured spouse or partner with gun during domestic dispute -code as 1.
• Police injured someone with handgun, but not in the line of duty - code as 1.

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Coding Intent - Unintentional (accidental) Unkown Intent

Code 0 (Unintentional/Accidental or unknown) includes all injuries and poisonings not inflicted by deliberate means including incidents described as "accidents" regardless of who inflicted the injury. Also included are cases where the emergency department record contains no indication of intent.

Includes:

• 8 year old accidentally shot self with handgun - code as 0.
• Painter fell off of ladder and fractured foot - code as 0.

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Coding Locale

Use the codes listed below to indicate where an incident took place:

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Coding Fire

Use the following codes to show whether the incident involved smoke inhalation, unexpected flames or smoke, or unexpected spread of flames or smoke:

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Coding Occupational (Work Related) Injury

Use the following codes to indicate that an injury or illness occurred while the victim was involved in a work-related activity.

*Note: Only firearm related cases will be accepted as work-related - codes 1 & 3.

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Race

Use the following codes to indicate the patient’s race as it is indicated in the ED record. Use “Other” for the race if it is not white or black.

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Comment Line

Every case must include descriptive comments or remarks. Enter these notes on the two lines labeled "Comment" that immediately follow the coded entries in PC-NEISS. The comments should include:

• A description of what the victim was doing when the injury occurred (sequence of events).
• The product(s) involved.
• The locale of the incident.
• Verbatim quotes of the words actually used in the emergency department record.
• A description of the patient’s complaints and treatment received if the ED record contains no diagnosis by medical personnel.

Refer to the ED notes of the physician, nurse, and clerk for pertinent information.

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Comment Line - Product Description

In the “Comment” text field, please include the brand name or manufacturer of the product associated with an injury whenever such information is available. Remarks like "doll made in Taiwan" or "English bicycle" are helpful in the absence of any other product identification.

Whenever possible, report specific products rather than general types of products:

In addition:

• Product codes for sports also require identification of the game involved as well as any equipment or apparel associated with the injury.
• Whenever code 1866 (General home or room involvement in fires) is used, the comments should include the room involved (such as bedroom or kitchen), if known.

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FAQ - Products & Product Codes

Q: When do we report child car seat injuries?
A: Report all child car seat injuries except those that occur in a motor vehicle crash.

Q: When and how do we report injuries associated with "cement"?
A: Only code cement (household structures 1876) if it is being used as a construction material. A finished structure made of cement should be coded (walls) or not coded (sidewalks) depending on the structure. Do not report cases (e.g., fell on cement...) where there is no information on the structure.

Q: How should we code a T-ball injury?
A: Use the code for baseball (5041).

Q: When should we report a motor vehicle injury?
A: Report motor vehicle injuries only if a consumer product was also involved or you are participating in a special study such as the firearms study and the case qualifies for reporting under that study.

Q: When should I use product code 9999?
A: Use product code 9999 only when an incident appears to be reportable but you cannot find an appropriate product code in the manual. Your NEISS representative will call or use the error message system to send you instructions on the code to use. Do not use 9999 for special study cases.

Q: When should I report injuries involving antifreeze?
A: Report injuries associated with antifreeze using product code 0966, unless the report mentions a motor vehicle as the source of the antifreeze.

Q: When should I report injuries associated with car batteries and car jacks?
A: Report all injuries associated with car jacks and car batteries.

Q: Should we report injuries involving motorized vehicles?
A: Report injuries involving mopeds, dune buggies, all-terrain vehicles and other non-licensed vehicles. Do not report injuries where the only product mentioned is an automobile, truck, motorcycle or other licensed motor vehicle unless you are participating in a special study like the work-related study and the case qualifies under that study.

Q: When should the code for construction materials be used to code items such as pieces of tin, wood or cement?
A: In general, such items are not reportable. Use the construction materials code only when there is indication that the material is being used or is planned to be used in a construction project.

Q: When should the product code for wrestling be used?
A: The code should be used for injuries associated with participating in or practicing for the sport of wrestling. The code should not be used for situations where the word wrestling is used to describe playing or fighting. Specifically, use the code when there is any indication of the formal sport. Do not use the code when the locale is home and there is no indication that the victim was practicing the sport.

Q: When should we use the various codes for two-wheeled vehicles (bicycles)?
A: If the vehicle has no motor, use the code for bicycles (5040) unless the record specifically states mountain bike (all terrain bike), and then use the mountain bike code (5033).
If the vehicle has a motor, use one of the following codes: 1) if the vehicle is described as a dirt bike or trail bike, use the dirt bike code (5036). 2) if the rider pedals and uses the motor only for assistance, use the moped code (3215). 3) if the vehicle is described as a minibike or pocket bike, use the minibike code (5035).

Q: How should we code injuries associated with child safety devices such as outlet covers, cabinet latches and table guards?
A: Use the code for the associated product and mention the child safety feature by using the word "protective" in the narrative.

Q: Do we report injuries associated with store displays or signs?
A: Report injuries associated with store displays or store signs using the product code for public use items (1738). Do not report injuries associated with traffic signs or other government property such as fire hydrants and manhole covers.

Q: How do we code the product in a case which indicates "victim fell off standard adult bed"?
A: Use product code 4076 for "Beds or bedframes, other or not specified". This code covers regular adult beds as well as beds, not specified.

Q: When should I report an injury involving a homemade product?
A: Report injuries associated with homemade products using the same rules as for injuries with manufactured products.

Q: How should I code a case where a product mentioned in the scenario is not present at the time of the incident? For example: Victim stepped on rusty nail – was not wearing shoes.
A: Do not code non-existent products or activities, but be sure to mention such products in the narrative.

Q: How should we code combination products such as crib/playpens and combination sofa/recliner chair?
A: If the coding manual has no code for the combination product, code it according to the description of usage at the time of the injury. For example, “Pt got hand caught in recliner portion of sofa” should be coded as recliner chair (0670).

Q: How should I code the component part of a consumer product for example, a sewing machine needle or a bunk bed ladder?
A: Do not code a component part separately. Use the code for the entire product. In the example, a sewing machine needle would be coded as the sewing machine (0112), and a bunk bed ladder would be coded as the bunk bed (0661).

Q: How should safety playground surfacing be coded?
A: If the victim falls from an item of playground equipment to a safety surface below (e.g. mulch, manufactured mats, pea gravel, etc.), code the item of playground equipment and mention the type of surfacing in the comment line. If no equipment is mentioned, do not code the surfacing.

Q: Should we code batteries when they are mentioned as a part of another product (i.e., hot batteries in a flashlight)?
A: Batteries are an exception to the component part rule, and should be coded separately from the product. For the example above, both the flashlight (0639) and the batteries (0884) should be coded.

Q: How should we code logs used in a fireplace?
A: Wooden logs are not considered fireplace equipment, and should not be coded. Non-wood logs that are sold specifically to be burned in a fireplace should be coded as fireplace equipment (0663).

Q: How should we code cases where the victim was hunting at the time of the injury?
A: Report hunting injuries using product code 7878.

Q: How should we code poles?
A: In general, code poles as 1865. When the locale is street or highway (4), assume the pole mentioned is a telephone pole or light pole and do not code. These types of poles are excluded from product code 1865.

Q: When should we code signs?
A: If a sign is mentioned in the comment and the locale is 4 – street or highway, or the scenario involves an MVA, then assume the sign is a traffic sign and do not code. If the sign is specified as being anything other than a traffic sign, use product code 1738 – public use items.

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FAQ - Coding Diagnosis and/or Body Parts

Q: Which poisoning (and chemical burn) cases do we report?
A: Report all accidental poisonings (and chemical burns) to children under age 5. First look for product code in manual, if there is no product code use product code 5555.
Report all accidental poisonings (and chemical burns) for all ages associated with consumer products (exclude drugs, medicines, cosmetics, and pesticides).

Q: When should I report scald injuries involving hot liquids without mention of other products?
A: Report injuries where a codeable product including hot water is mentioned in the scenario. Do not report injuries associated with coffee or other foods unless a product (container, stove, etc.) is mentioned.

Q: When should I use the codes for poisoning, ingestion, aspiration, foreign body and anoxia?
A: Use poisoning (68) for ingestion of a soluble substance and inhalation of vapors, gases or fumes, except carbon monoxide and smoke from fires.

Use aspiration (42) when a substance is caught in the nose, throat or lungs (e.g. choked on a dime). Also use aspiration when the patient choked on a liquid and the record indicates the victim aspirated.

Use ingestion (41) when above diagnoses do not apply, and the victim has swallowed a non-soluble substance (e.g. swallowed a dime).

Use anoxia (65) when above diagnoses do not apply but the victim was unable to obtain sufficient oxygen either because breathing was hampered (e.g. suffocation, strangulation) or not enough oxygen was available (e.g. carbon monoxide, smoke from fires).

Use foreign body (56) when above diagnoses do not apply and object is embedded in victim by force (splinter lodged in arm).

Q: When should the body part code 84 - (25-50% of body) be used?
A: In general, code the specific body part (and injury) associated with the most severe injury.
Use body part code 84 when a burn injury scenario specifically states that 25-50% of the body was burned, or when the record states that multiple body parts are involved but does not identify any specific body part.

Q: How should we code diagnosis when the only information on the ER record is that the patient was suffering pain, swelling, infection or other symptoms?
A: When the only injury information on the ER record is that the patient was suffering pain, swelling, or other symptoms, code the diagnosis as “Other/Not Stated”(71), and mention the pain, swelling, or other symptom in the ‘Diagnosis Other’ narrative field.

Q: When is it appropriate to use the diagnosis “Not Stated”?
A: Use the diagnosis code 71 for ‘Other/Not Stated’ when there is no information on the injury. Use this diagnosis code for comments such as ‘Left without being seen’ or ‘Normal Exam’.

Q: How should we code a diagnosis of hematuria or ‘blood in the urine’?
A: If the record shows a diagnosis of hematuria, the diagnosis and body part should be coded as 62 – ‘internal organ injury’ and 79 – ‘lower trunk’.

Q: How should we code the body part when the comment states “multiple contusions or abrasions”?
A: Code the body part for multiple contusions or abrasions as 87 – not stated unless more specific body parts are mentioned in the hospital record.

Q: How should we code head injuries?
A: When coding head injuries, code the most specific diagnosis given. When there is no specific diagnosis for a head injury, it should be coded as an internal organ injury (62). Coding the most specific diagnosis should not take precedence over coding the most severe injury. For example, “internal” head injuries such as subdural hematoma, hemorrhaging, etc. should also be coded as internal organ injury (62). If the diagnosis only states ‘hematoma to the head’, then the diagnosis should be coded as hematoma (58). When there are two injuries even to the head, code the most severe.

Q: How do we code the diagnosis for “foreign body sensation”?
A: If the foreign body sensation is from ingesting a substance, use diagnosis code 42 – aspirated foreign object.

Q: How should we code bodypart and diagnosis for diaper rash?
A: Code diaper rash as diagnosis 74 – dermatitis and bodypart 79 – lower trunk.

Q: How should we code a diagnosis when the record states that a specific diagnosis is 'possible' or is being 'ruled out'?
A: When the record states that a diagnosis is 'possible' or it is being 'ruled out', code the possible diagnosis only if there is no other specific diagnosis to code.

Q: What diagnosis code should be used for rashes that are described as 'hives' or 'urticaria'?
A: If a rash is described in the ER record as hives or urticaria, use the diagnosis code 71 for 'Other/Not Stated', and mention the hives or urticaria in the 'Diagnosis Other' narrative field.

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FAQ - Other Questions

Q: When should I report work-related injuries?
A: Do not report work-related injuries unless you are participating in the firearms special study and the case qualifies under that study.

Q: When is it appropriate to use the "home" locale?
A: Use the home locale when the record contains information that the injury occurred at a home. Code "home" when the record contains phrases such as "in backyard", "at sister's apartment", or "in his garage".

Q: Should I report a case where no product is mentioned but the garage is mentioned as a location?
A: Do not report injuries occurring in garages unless a reportable product is involved, the incident was a fire or carbon monoxide poisoning or the case is otherwise reportable under a special study.

Q: When the record states “left without being seen” or “eloped”, what disposition code should be used?
A: Use disposition code 6 – ‘Left without being seen’ when the record states that the patient left against medical advice or left without being seen.

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