Current RMA Instruments
Reasonable Hypothesis SOP | 37 of 2025 |
|---|---|
Balance of Probabilities SOP | 38 of 2025 |
Changes from previous Intruments
ICD Coding
- ICD-10-AM Codes: S01, S00, S04, S05, S06, S08, S11, S14, S15, S19, S20, S21, S24, S25, S27, S29, S31, S34, S35, S36, S37, S40, S41, S44, S45, S49, S50, S51, S55, S58, S59, S60, S61, S64, S65, S68, S69, S70, S71, S74, S75, S78, S79, S81, S84, S85, S88, S89, S90, S91, S94, S95, S98, T05, T06, T09.1, T11, T13.1, T14, T79
Brief Description
This SOP covers injuries that breaks the surface of the skin or other exposed tissue (e.g. eye, mouth, nail bed etc.). The wound may or may not go deeper into the tissue under the skin or involve deeper structures.
The name of this SOP should not be used as a diagnostic label for claims. The diagnostic label should be changed to one (or more) that accurately describes the relevant injury or injuries. In someone with multiple traumatic injuries, consider whether there is another injury related SOP that better fits the claim before applying this SOP. Whether more than one SOP should be applied for a multiple injury scenario from one incident will depend on the circumstances of the case. If in doubt, further medical advice should be sought.
Other SOPs that may be relevant when dealing with acute traumatic injury causing a cut, stab, abrasion or laceration include:
- Concussion
- Moderate to severe traumatic brain injury
- Fracture
- Traumatic contusion or haematoma
- Heat-induced burn
- Explosive blast injury
- Gunshot injury
Confirming the diagnosis
The diagnosis can be confirmed based on a record of injury or report from a medical practitioner. Additional specialist opinion is generally not required.
Additional diagnoses covered by SOP
- Friction burns
- Needlestick injury
Conditions not covered by SOP
- Dental abrasion * Tooth wear SoP
- Burns other than friction burns* - Heat-induced burn, chemical burn, electrical injury, retinal burn or radiation burn SOP may apply
- External bruise, traumatic contusion or haematoma* - Traumatic contusion or haematoma SoPs
- Gunshot wounds * Gunshot injury SoP
- "Lacerations" of internal organs from non-skin-penetrating injuries # or * - Explosive blast injury SoP may apply
- Wounds caused by missiles * - Explosive blast injury SoP may apply or other SoPs
- Wounds caused by explosive device or fragment thereof * - Explosive blast injury SoP may apply or other SoPs
* another SoP applies
# non-SoP condition
Clinical onset
Clinical onset will be at the time of the relevant injury.
Clinical worsening
The SOPs have only an inability to obtain appropriate clinical management factor for clinical worsening. Treatment depends on the location and extent of the injury. Lack of appropriate treatment at the time of or shortly after an injury could result in worsening, including death. Examples of clinical worsening may include poor wound healing or infection.