# Self Cutting w/no suicidal ideation



## jmonson

I am aware of the E code E956 "Suicide and self-inflicted injury by cutting and piercing instrument"; however, what if the patient is cutting themselves without the intention of suicide? This seems to be a very common scenario these days, but I don't exactly want to attach "suicide" to a patient's chart when they are not in fact "suicidal" per se. Any suggestions?


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## ohn0disaster

jmonson said:


> I am aware of the E code E956 "Suicide and self-inflicted injury by cutting and piercing instrument"; however, what if the patient is cutting themselves without the intention of suicide? This seems to be a very common scenario these days, but I don't exactly want to attach "suicide" to a patient's chart when they are not in fact "suicidal" per se. Any suggestions?



Definitely don't use the E-code, as you said it specifically states that the patient is not suicidal. Also, E-codes must be used ONLY in addition to a code from one of the main chapters of ICD-9-CM, to indicate the cause. The code selection that you are seeking is for "Self Mutilation". In your index, self mutilation codes to 300.9, which is for *unspecified nonpsychotic mental disorder*.

Hope this helps!


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## msrd_081002

*ICD: INJURY CODE+E code (self-inflicted)*




ohn0disaster said:


> Definitely don't use the E-code, as you said it specifically states that the patient is not suicidal. Also, E-codes must be used ONLY in addition to a code from one of the main chapters of ICD-9-CM, to indicate the cause. The code selection that you are seeking is for "Self Mutilation". In your index, self mutilation codes to 300.9, which is for *unspecified nonpsychotic mental disorder*.
> 
> Hope this helps!



--------------------------------------------------------------------------------------------------------
The CODE E956 IS CORRECT.
Please go through the below specified explanation.

*Please read the conventions for the ICD 9 CM Section 1.*
7. "And"
*The word "and" should be interpr**eted* *to mean eiher "and" or "or" when it appears in a title.*
Applying the convention
The tiltle reads  E956 Suicide* "and" *self-inflicting injury by cutting and piercing instruments.

Referring to *E code use for Self inficted injury*
Pls go through 19. Ecode guideline.It reads:

Ecode captures the *"intent"*
1. Suicide or *Self inficted injury*
2. for purposely inflicted injury.......

I'll assign ICD injury code from INJURY chapter * +  "intention" captured in the ECODE.* &
I'd verify the priors to confirm Physician dx'ed mental disorder if "ANY" 

I'd disgree assigning 300.9 Psychoneurosis, as it cannot be dx'ed /assigned by the coder Without Physicians documentation of the DX
Though Self-harm (SH) or deliberate self-harm (DSH) includes self-injury (SI) and self-poisoning and is defined as the intentional, direct injuring of body tissue without suicidal intent refers to self mutilation, the code is for Psychoneurosis. Per guideline, should NOT be assigned by the coder without Physicians' dagnosis. 



Thanks


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## mitchellde

I agree E956 is the correct E code, however it cannot be the first -listed dx, there must be a different code, If this is the acute encounter then, use a wound code first.  However if this is a counseling encounter then you will need to look and see if the provider has documented a psych dx or if you should use a V code for the couseling with the E code.


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## ohn0disaster

After reviewing the E-code, as I never did in the first place, I also agree the the E-code is correct to use. I'm unsure as to the content of patient encounter so I'm honestly not sure whether my initial code selection holds true. I'm not sure why I was so quick to choose the dx that I originally suggested without further documentation clarification. 

Anyway, if the patient came in and doctor documents the patient as a 'self cutter', that is a mental disorder called Self Mutilation aka Self Harm, Deliberate Self Harm, and Self Injury. This falls under the code that I intially posted. However, if the patient comes in to see doctor with a cut, obviously my initial code selection does not hold true. 

Again, I apologize for being so quick as to post a response without being clear on the situation. We're all entitled a 'duh' moment, no?! ;p

EDIT:
Also, I wanted to add that I have heard that when we switch to ICD-10, there will be specific codes for these behaviors. So that will eliminate the hesitancy to tack on a mental disorder code for self cutters, which is good since it's pretty common among teens and young adults these days. From what I've seen, self cutting is something that a lot of people "grow out of", which I find somewhat strange but I digress.


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## msrd_081002

mitchellde said:


> I agree E956 is the correct E code, however it cannot be the first -listed dx, there must be a different code, If this is the acute encounter then, use a wound code first.  However if this is a counseling encounter then you will need to look and see if the provider has documented a psych dx or if you should use a V code for the couseling with the E code.



Please read my post. I was just explaining about the ECODE use/guidelines.
I've *NOT* mentioned to use it as PDX. 
I've clearly mentioned 
"I'll assign ICD injury code from INJURY chapter *"+" *"intention" captured in the ECODE. &
I'd verify the priors to confirm Physician dx'ed mental disorder if "ANY"

Thanks.


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