Got External Cause Coding Questions? We’ve Got Answers

Posted on 14 Feb, 2019 |comments_icon 0|By Bruce Pegg
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If you’re tempted to stop at the point where the ICD-10 coding guidelines for Chapter 20 say “there is no national requirement for mandatory ICD‐10‐CM external cause code reporting” and think that there’s no need for you to document external causes of morbidity codes for your patients with injuries, you could be forgiven.

But the fact is, if you don’t use codes from the V00-Y99 range to pinpoint “environmental events and circumstances as the cause of injury, and other adverse effects,” you’re not telling the whole story of the patient’s condition. When that happens, you might be creating problems for your practice and your patient. You could also be denying revenue opportunities for your practice and benefits to medical researchers and policy makers, too.

So, what exactly are these codes? More, why are they important? Here are five of the most frequently asked questions about the external cause codes, along with detailed answers to help you know how, when, and why to use them.

Question: What Do External Codes Report?

Answer: External cause codes “capture how the injury or health condition happened (cause), the intent (unintentional or accidental; or intentional, such as suicide or assault), the place where the event occurred the activity of the patient at the time of the event, and the person’s status (e.g., civilian, military),” according to ICD-10. Some examples include

  • Cause: W55.03XX (Scratched by cat)
  • Intent: X78.1XXX (Intentional self-harm by knife)
  • Place: Y92.003 (Bedroom of unspecified non-institutional (private) residence as the place of occurrence of the external cause)
  • Activity: Y93.18 (Activity, surfing, windsurfing and boogie boarding)
  • Individual’s Status: Y99.0 (Civilian activity done for income or pay)

Question: How Many Codes Should I Report?

Answer: ICD-10 guideline 20.a.4 states you should “assign as many external cause codes as necessary to fully explain each cause.”

Question: When Should I Report Them?

Answer: ICD-10 guidelines for reporting external causes state that even though “there is no national requirement for mandatory ICD‐10‐CM external cause code reporting,” you may be required to report them when subject to “a state‐based … reporting mandate” or by “a particular payer.” But even if reporting an external cause is not required, doing so is always best practice – and in fact, correct coding.

Question: When Should I Not Report Them?

Answer: This question has two answers:

  1. You would not report an external cause code when the “external cause and intent” of the injury “are included in a code from another chapter (e.g. T36.0X1 – Poisoning by penicillins, accidental (unintentional))” according to ICD-10 guideline 20.a.8.
  2. Don’t use external cause codes beyond the initial encounter, in most cases. Only the place of occurrence, activity, and patient status need be recorded at the time of the injury (e.g. at a hospital emergency room or an urgent care center). At subsequent encounters, you only need to report the external cause code itself for the length of the injury.

Question: Why Should I Report Them?

Answer: Again, there are several answers to this question.

  1. Payers may expedite a claim because you have provided full and detailed information to justify the level of care your physician has provided.
  2. Payers may require them, especially if the injury creates issues of liability. For example, a Y92 (Place of occurrence of the external cause) code could shift the responsibility for payment from the medical carrier to the place of occurrence.
  3. Reporting external causes may reveal quality-improvement opportunities for your practice. For example, suppose your provider sees a patient and you record S06.0X1A (Concussion with loss of consciousness of 30 minutes or less, initial encounter) with the external cause code W21.01XA (Struck by football, initial encounter). This could lead to your provider initiating baseline concussion testing for your football-playing patients.
  4. Reporting can help improve the process of data collection for researchers and policy makers.

Learn More

Stay informed, get answers to your reporting questions, and find the help you need to secure your deserved pay —  with your risk-free subscription to ICD-10 Coding Alert. Every issue of this monthly newsletter delivers coding and billing guidance, as well as high-impact tips and strategies to conquer the revenue-risking challenges that threaten your claims and compliance success.

Nail down correct diagnosis coding with ease in this comprehensive 2019 ICD-10-CM for Physicians & Hospitals that includes coding tips and definitions of medical terms throughout the Tabular List. New chapters are included to introduce you to Risk Adjustment and Hierarchical Condition Categories (HCCs) and MACRA: MIPS and APMs. You can easily prepare for coding certification exams with the expert exam prep tips included in the book, along with 60 stick-on tabs to mark specific sections of the book, making page navigation quick and easy. ICD-10-CM Official Guidelines for Coding and Reporting 2019 are in the front of the book for fast reference and also include flow charts for assigning the correct codes.

Author

Bruce Pegg
Editor, Newsletters

An experienced teacher and published author, Bruce is TCI’s new voice of primary care, delivering advice and insights every month for coders in the fields of family, internal, and pediatric medicine through Primary Care Coding Alert and Pediatric Coding Alert. Additionally, he is the current editor of E/M Coding Alert. Bruce has a Bachelor of Arts degree from Loughborough University in England and a Master of Arts degree from The College at Brockport, State University of New York. He recently became a Certified Professional Coder (CPC®), credentialed through AAPC.

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