# External Cause Codes - comes in for injury



## rjenn86 (Oct 23, 2015)

When pt comes in for injury and primary doesn't require the external cause codes, activity codes, etc. But secondary ins does, do we need to bill them out? Or is it ok not too since primary doesn't require them? Thank you


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## consultingbykristin (Oct 23, 2015)

It's more about correct coding than which insurance requires what codes.  That being said, looking at the guidelines, they say

"There is no national requirement for mandatory ICD-10-XM external cause code reporting."  In the absence of a mandatory reporting, providers are encouraged to voluntarily report external cause codes as they provide valuable data for injury research and evaluation of injury prevention strategies.

After looking at both of those items, I would say, use your office Coding Instructions to determine how to handle this.  Do you have an internal guideline that states we never report external causes?  Or one that says we'll only report to carriers we know need the info?

Interesting to hear what others may say---great question.


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## ggeeorge (Oct 23, 2015)

Our office policy is to report all external cause codes.  However, I have noticed this will quite often cause the insurance carrier to generate a questionnaire to the patient for other information (i.e. looking for third party liability) - and can delay payments if the patient fails to respond.


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## RFoster1 (Oct 26, 2015)

*External Cause Codes*

I find that insurance companies send out a questionnaire based on the injury code rather than the external cause code.  I'm hoping the external codes will  help diffuse some of the questionnaires.  Time will tell.


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## elizabeth24 (Oct 27, 2015)

Our policy is to assign external cause codes unless the patient is self-pay.


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## cgros2128 (Oct 28, 2015)

hi. I am currently taking the online course to ICD-10 CM and I am stuck on Chapter 20. have tried everything I can think of to find these external cause codes and I am completely lost. Can you please help?


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## mitchellde (Oct 28, 2015)

Use the index in the front .  It is the index after the table of drugs and chemicals, it states index to external causes at the top of the pages.  Then look under broad terms such as "fall" or "assault" or "burn" or "bitten" or "struck" then for the place of occuance look under "place", for the activity look under "activity".  Remember to verify the codes using the tabular as many need placeholders and 7th characters.


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## jeskla (Oct 28, 2015)

*In my experience, yes.*

Yes, it seems in your situation that if you want to get paid for the secondary claim, then you will need to add the external cause codes to the primary claim. Once the primary insurance processes and pays their portion, then the claim will have everything it needs for the secondary insurance to process it.

Jamie, CPC-A
Orthopedic coder


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