Date amended:
External
Statements of Principles
Current RMA Instruments
Reasonable Hypothesis SOP
23 of 2020
Balance of Probabilities SOP
24 of 2020
SOP bulletin information for new Instruments

Document

ICD Coding

Multiple ICD codes potentially apply depending on the specific nature of the injuries.

  • ICD-9-CM Codes: From within the range 851 to 957 (not all codes in this range apply)
  • ICD-10-AM Codes: From withIn the range S00 to T07 (not all codes in this range apply)
Brief description

The gun shot injury SOP covers any physical injury from (being struck by) a non-explosive projectile fired from any type of gun (including a hand gun, rifle, machine gun, or shotgun).

Such injuries may also be covered by other SOPs.  The most appropriate SOP for the circumstances of the claim should be applied.  More than one SOP may be applicable depending on the specific circumstances. The name of the SOP should not be used as a diagnostic label for claims.  The diagnostic label should be changed to one that accurately describes the relevant injury or injuries.

Confirming the diagnosis

The diagnosis can be confirmed based on a record or report from a medical practitioner.  Specialist opinion is not required.

Other SOPs that may be relevant for gunshot injury include
  • Moderate to severe traumatic brain injury
  • Fracture
Conditions not covered by gunshot injury SOP
  • Explosive blast injury*
  • Acute stress disorder*
  • Post traumatic stress disorder*
  • Sensorineural hearing loss*

* another SOP applies

Clinical onset

Clinical onset is not a term used in any SOP factor for this SOP, but the clinical onset will be at the time of the relevant injury.

Clinical worsening

The SOP has only an inability to obtain appropriate clinical management factor for clinical worsening.   This could only be relevant in the unlikely scenario where the gunshot injury was non-service related, but the treatment provided (for the direct effects of the gunshot) was service-related.