External Cause CodingCorrie Alvarez, CPC, CPMA, CEDC, CPC-I

Agenda Quick Review of ICD-10 Injury Coding

Guidelines for Coding External Causes

Overview External Cause Coding

Five Coding Scenarios

Chapter 19 Guidelines Coding of Injuries (I.C.19.b)

When coding injuries, assign separate

codes for each injury unless a combination

code is provided, in which case the

combination code is assigned. Code T07, Unspecified multiple injuries should not be

assigned unless information for a more specific code is

not available.

Guidelines ContinuedSuperficial Injuries

Superficial injuries such as abrasions or contusions are not

coded when associated with more severe injuries of the

same site.

Primary Injury with Damage to Nerves/Blood Vessels

When a primary injury results in minor damage to peripheral

nerves or blood vessels, the primary injury is sequenced first

with additional code(s) for injuries to nerves and spinal cord

and/or injury to blood vessels.

Example A patient not wearing a seatbelt was involved in an

automobile accident, hit the windshield, and was

treated in the emergency room for a laceration to the

scalp.

The correct ICD-10-CM code would be S01.01XA for

the Laceration without foreign body of scalp

Definitions Incision-cut by sharp instrument

Knife, glass, scissors

Laceration-skin cut/torn. May be shallow or deep. Usually by blunt trauma (bat)

Abrasion-Skin scraped or rubbed off

Puncture-Sharp object enters skin. Usually small (nail or cat bite)

Wound-General term. Integrity of tissue is compromised

Fracture Coding

The Principals of multiple coding of injuries

should be followed in coding fractures. A fracture not indicated as open or closed should be

coded to closed. A fracture not indicated whether

displaced or not displaced should be coded to displaced.

Seventh CharactersInitial vs. Subsequent Encounter for Fractures

Traumatic fractures are coded using the appropriate seventh character extension for initial encounter (A, B, C) while the patient is receiving active treatment for the fracture.

Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and treatment by a new physician.

The appropriate 7th character for initial encounter should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion.

Steps to Coding Fractures Anatomical Location

Type of Fracture

Open/Closed

Displaced/Non-Displaced

Code This Greenstick fracture, of shaft of left ulna. Healing well.

Displaced fracture, distal phalanx, right thumb, initial

encounter

Answers Greenstick fracture, of shaft of left ulna. Healing well.

S52.212D

Fracture, ulna, shaft, greenstick

Displaced fracture, distal phalanx, right thumb, initial

encounter

S62.521A

Fracture, thumb, distal, displaced

External Cause VO1-Y99 Injury Research

Prevention Strategies

Streamline claim submission and payment adjudication

Not mandated unless provider has state-based

mandated reporting requirement or specific payer

requirement.

External Cause Guidelines I.C.20.

External Cause Coding Codes V, W ,X and Y

V00-V99 are separated into 12 groups based on

patient’s mode of transportation

W codes are for slipping, tripping, stumbling or falling.

W20-W49 are codes for “exposure to inanimate

mechanical forces”.

External Cause Coding Y codes are for place of occurrence (Y92-) and activity

codes (Y93-)

Y99- describe the patient’s status. For example,

injuries occurred while working as a civilian, while in

the military or as a volunteer.

Coding External CausesUsed with Any Code in the Range of A00.0-T88.9, Z00–

Z99

An external cause code may be used with any code in

the range of A00.0–T88.9, Z00–Z99, classification that

is a health condition due to an external cause

E.Coli, Cryptosporidium, Shigellosis infections due to

swimming

Myocardial Infarction due to running on treadmill

External Cause Coding External Cause Code Used for Length of Treatment

Assign the external cause code, with the appropriate

seventh character (initial encounter, subsequent

encounter or sequela) for each encounter for which the

injury or condition is being treated.

External Cause CodingExternal Cause Code Can Never Be a Principal Diagnosis

• An external cause code can never be a Principal (first-listed) diagnosis.

Place of Occurrence Guideline

• Codes from category Y92, Place of occurrence of the external cause, are secondary codes for use after other external cause codes to identify the location of the patient at the time of injury or other condition.

• A place of occurrence code is used only once, at the initial encounter for treatment. No seventh characters are used for Y92.

• Do not use Y92.9, if place is not stated I.C.20.b

External Cause Coding Activity Code

Codes from category Y93, Activity code, are secondary codes for use with other external cause codes to identify the activity of the patient at the time of the injury.

An activity code is used only once, at the initial encounter for treatment. Only one code from Y93 should be recorded on a medical record.

Do not report Y93.9, unspecified activity, if the activity is not stated. I.C.20.c

External Cause CodingMultiple External Cause Coding Guidelines

If two or more events cause separate injuries, an external cause

code should be assigned for each cause. The first-listed external

cause code will be selected in the following order:

External cause codes for child and adult abuse take priority over all other

external cause codes

External cause codes for terrorism events take priority over all other

external cause codes except child and adult abuse

External cause codes for cataclysmic events take priority over all other E

codes except child and adult abuse and terrorism

External cause codes for transport accidents take priority over all other

external cause codes except cataclysmic events and child and adult abuse

and terrorism

External Cause Coding Use the full range of codes to fully describe

Cause, intent

Place of occurrence

Activity of the patient (if applicable)

Patient Status

If format limits the number you are able to report

(I.C.20.e)

External Cause Coding Child and Adult Abuse Guidelines

Adult and child abuse, neglect and maltreatment are

classified as assault.

For confirmed cases of abuse, neglect and

maltreatment, when the perpetrator is known, a code

from Y07.

External Cause Coding Late Effects of External Cause Guidelines

Late effects are reported using the external cause code with the seventh character extension “S” for sequela.

External Cause Status

A code from category Y99 should be assigned whenever any other external cause code is assigned for an encounter including an Activity code.

Assign a code from category Y99 External cause status to indicate the work status of the person at the time the event occurred.

Main Terms Remember: Separate Index

Fall, Kicked, Slipping, Strike against, Struck (etc.)

PLACE of occurrence*

ACTIVITY*

EXTERNAL Cause Status* (do not assign code Y99.9

unspecified)

*ONLY USED ONCE at initial visit

ICD-10 Rules for External Cause

Coding

Consider how the accident happened

Consider where the accident occurred

Consider what activity was the patient engaged in

when the accident happened

External cause code status: indicate whether the

accident or injury happened during a paid or volunteer

activity (Y99.0-Y99.99)

Do not assign code Y99.9 (unspecified) I.C.20.k

You Try It!! A 30-year-old patient was at a sports gymnasium,

participating in a tap dancing contest to raise funds for

muscular dystrophy. She slipped on the gym floor and

fell, injuring her left ankle. The ankle was X-rayed and

no fracture was evident. Her ankle was wrapped in an

ACE™ bandage and she was given proper RICE

instructions. She will f/u with her provider in 3 days.

Final diagnosis: left ankle sprain.

~Remember the Rules~ Never used as a primary diagnosis

Consider how the accident happened

Consider where the accident occurred

Consider what activity was the patient engaged in

when the accident happened

External cause code status: indicate whether the

accident or injury happened during a paid or volunteer

activity (Y99.0-Y99.99)

Answer Sprain, left ankle:

Slip, fall (same level):

Place: Sports, gym:

Activity: Dancing:

Status: Volunteer Activity

HOW DID YOU DO?????

Try This! Chuck Fast, a professional dog sled racer, was injured,

while competing for the 100k purse in the annual

Kuskokwim 300 race in Bethel, Alaska. He was 10

miles out in the wilderness when his sled hit some

rocks and he hit his head against a boulder. He

suffered a small scalp laceration that was cleaned and

dressed and he was able to continue the race.

Answer Laceration scalp

Accident/ transport/ animal drawn vehicle/ collision

(with)/fixed or stationary object

Striking against/object

Place/Wildness area

Activity/Sledding

External Cause/civilian activity/income

Try This! A 10-year-old was skateboarding in a public park. He

fell and suffered an injury to his left radius.

He is taken to the emergency room where an x-ray

revealed a Colles’ fracture, in good position and

alignment so a cast was applied to prevent further

damage and allow good healing.

He will follow up with an orthopedic in 2 weeks.

Answer Colles’ Fracture

Accident/transport/pedestrian/conveyance/skateboard

Place/Park (public)

Activity/Skateboarding

External Cause/Recreation Sport, Hobby, Leisure

Try This! A 37-year-old patient works as a data-entry operator.

Around 11:00 AM today, while at the computer, she

suddenly felt pain and numbness in her right wrist and

notified her supervisor that she needed to see a

physician. She was sent to an urgent care facility for

treatment where the provider diagnosed her with carpal

tunnel syndrome, right wrist. She was given

medication and a wrist splint with instructions to rest

and not work for 10 days. She will follow up in a week.

Answer Syndrome/Carpal Tunnel/right

Place/Office Building

Activity/Keyboarding

External Cause/Civilian activity for compensation

How would you code the follow up visit?

Code This! While watching the Angels play a baseball game in

Anaheim, a 50-year-old patient got hit by a foul ball. He

was struck in the nose and suffered a nasal fracture.

He was taken to the Emergency Room for treatment.

Answer Fracture/nose

Struck (accidently) by ball/baseball

Place/sports area/stadium

Activity/Spectator at an event

Wrap Up

Share with you a few of my favorite

codes

My Favorite Codes BITTEN BY ORCA W56.21XA

BURN OUT Z73.0

HOBO Z39.0

CONTACT WITH HOE W27.1XA

PROBLEM WITH MOTHER-IN-LAW Z63.1

STRUCK BY A TURTLE W59.22XA

WALKED INTO WALL W22.01XA

Questions?

Contact Information

corriealvarez@aol.com