External Cause Coding Corrie 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 Continued Superficial 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 Characters Initial 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 Causes Used 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 Coding External Cause Code Can Never Be a Principal Diagnosis An external cause code can never be a Principal (firstlisted) 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 Coding Multiple 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