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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?
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