Note29  Multiple fractures of sites classifiable to the same three-or four-digit category are coded to that category, except for sites classifiable to 810-818 or 820-827 in different limbs.

Multiple fractures of sites classifiable to different fourth-digit subdivisions within the same three-digit category should be dealt with according to coding rules.

Multiple fractures of sites classifiable to different three-digit categories (identifiable from the listing under "Fracture"), and of sites classifiable to 810-818 or 820-827 in different limbs should be coded according to the following list, which should be referred to in the following priority order: skull or face bones, pelvis or vertebral column, legs, arms.

Note30  Use the following fifth-digit subclassification with categories 800, 801, 803, and 804:

                        0          unspecified state of consciousness
                        1          with no loss of consciousness
                        2          with brief [less than one hour] loss of consciousness
                        3          with moderate [1-24 hours] loss of consciousness
                        4          with prolonged [more than 24 hours] loss of consciousness
                                    and return to pre-existing conscious level
                        5          with prolonged [more than 24 hours] loss of consciousness,
                                    without return to pre-existing conscious level

Use fifth-digit 5 to designate when a patient is unconscious and dies before regaining consciousness, regardless of the duration of the loss of consciousness

                        6          with loss of consciousness of unspecified duration
                        9          with concussion, unspecified