Toolkit Overview and Purpose


Effective October 1, 2015, the United States (U.S.) Department of Health and Human Services (HHS) required health care organizations and providers covered by the Health Insurance Portability and Accountability Act (HIPAA) to use International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) to report medical encounters when submitting electronic claims for administrative and financial transactions. Prior to October 1, 2015, the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) was used for coding medical encounters in the hospital setting, emergency department (ED), or outpatient offices. The transition from ICD‐9‐CM to ICD‐10‐CM profoundly affects local, state, and national injury and violence surveillance activities that use electronic claims files from hospitalizations and ED visits. Public health agencies use existing ICD-10-CM coded datasets for injury surveillance because the number of injuries is too many for agencies to afford to conduct injury surveillance by routinely collecting and analyzing their own data on injuries in their jurisdictions. For example, in the U.S. in 2017, there were more than 30 million injuries treated in EDs, over which, over three million were severe enough to require a hospitalization.1


In recognition of the need to build cross-jurisdictional consensus on ICD-10-CM-based injury and drug overdose surveillance methods, the Council of State and Territorial Epidemiologists (CSTE) ICD-10-CM Transition Workgroup and the CSTE ICD-10-CM Drug Poisoning Indicators Workgroup were created in partnership with the Centers for Disease Control and Prevention’s (CDC) National Center for Injury Prevention and Control (NCIPC) and the National Center for Health Statistics (NCHS).


CSTE was well positioned to convene and facilitate these two work groups for two reasons: 1) CSTE serves as the professional home for almost 2,000 epidemiologists representing all 50 states, many territories and many local and tribal jurisdictions; 2) CSTE routinely provides professional development to the epidemiologic workforce through communities of practice and workgroups, toolkits, webinars and an annual conference. This toolkit reflects the CSTE mission to:

  • Promote effective use of epidemiologic data to guide public health practice and improve health,
  • Support effective public health surveillance and epidemiologic practice through training, capacity development, and peer consultation, and
  • Develop standards for practice.


The purpose of this specific toolkit is to provide standardized guidance to epidemiologists and others who use ICD-10-CM medical administrative discharge data for injury and drug overdose surveillance. The surveillance guidance presented in this toolkit reflects the findings of these workgroups for measuring injury morbidity using ICD-10-CM coded hospitalization and ED visit discharge data. Guidance and surveillance definitions provided in this document may differ from surveillance reporting requirements associated with federal funding (e.g., Centers for Disease Control and Prevention grant and cooperative agreement reporting requirements for states, tribes, and localities)


Editors’ Notes on terminology:
  • The injury indicators presented in this toolkit, include all injury, drowning, fall-related injury, fire-related injury, firearm-related injury, assault, motor vehicle-related injury, nondrug poisoning, drug overdose, intentional self-harm, and traumatic brain injury (TBI). These injury indicators are derived from medical billing codes that use the ICD‐10‐CM system. Overlap exists among these indicators. For example, a poisoning-related injury could be included in both the poisoning injury indicator and the intentional self-harm indicator.
  • This toolkit focuses on medical administrative discharge data, which will be referred to as “discharge” data throughout this document. These data were not created for injury surveillance and are secondary data sources. The terms “discharge” and “billing” are often used interchangeably, however “discharge” has been used in other guidance documents and may be more familiar to practitioners.
  • The terms “overdose” and “poisoning” are often used synonymously. Throughout this toolkit the term “drug overdose” is used to describe drug-involved poisoning cases, while “poisoning” is used for nondrug involved cases.
  • The injury indicators below should be used to identify injury-related ED visits and hospitalizations, regardless of patient discharge disposition (e.g., discharged, deceased). However, this toolkit focuses on nonfatal injuries.


This toolkit provides guidance on:


  • Using standardized validation datasets to test analysis code on fictional data with a known answer
  • Understanding key differences between hospitalization and ED visit data and how that informs surveillance methodology
  • Reporting of standardized injury and overdose indicators
  • Recommendations for data presentation and visualizations
  • Concepts and terms used in ICD-10-CM injury and drug overdose surveillance
  • Additional resources for navigating the ICD-10-CM transition

CSTE ICD-10-CM Injury Surveillance Toolkit 11/19/2019. Toolkit Overview and Purpose. Retrieved from


Acknowledgement Statement: This product was developed by the CSTE ICD-10-CM Transition Workgroup, the CSTE ICD-10-CM Drug Poisoning Indicators Workgroup, and CSTE consultants with subject matter support and review from CDC/NCIPC and CDC/NCHS. Product development was supported in part by CDC Cooperative Agreement Number NU38OT000297-01-00.


The findings and conclusions in this report are solely the responsibility of the authors and do not necessarily represent the official views of the CDC or HHS.