# Does anyone really understand the application of External Cause E-Codes?



## ollielooya (Feb 27, 2012)

Colleagues, I posted this question in another category but thought it might be prudent to do it here as well.  The external Cause Status E code 000.9 is puzzling.  WHEN would it be used if we are instructed, "Do not assign code E000.9 Unspecified external cause status, if the status is not stated."  So, exactly, WHEN would one assign this code, and can someone furnish an example?  I'm not the only coder confused by this statement!

---Suzanne E. Byrum CPC


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## cblack712 (Feb 27, 2012)

If I have this right --- and I am pretty sure that I do because I have yet to receive a rejection for using it. Every "E" code after the E000.9 is a more detailed description of what happened to a patient. The E000.9 is getting it down to more describe the type of activity that the patient was involved in. For instance......
37yo White Male Marine Corp officer fell ill while completing a mandated tear gas training outside of his military post. Patient was wearing protective gear, however his training officer notes that upon his arrival to the scene the patients mask was not secured properly. 

I am only going to code the E codes for example purposes. 
Primary E code used is going to be the tear gas posioning  (E869.3)
External E code used would be E000.1 since the patient is military personnel and obtained the injury/illness while on duty during a training exercise. 

The E000.9 would be used if the report simply said that 37yo male fell ill after being exposed to tear gas. 

I have a bunch more examples if you need them!


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## ollielooya (Feb 28, 2012)

Thank you so much for jumping to my rescue and yes, would you mind posting some additional examples to this thread or contact me thru my yahoo messenger <ollielooya@yahoo.com> It seems like 000.8 is used more readily than 000.9 but that coding guideline still has me in the dark for some reason.  I sure appreciate your help with this. ---Suzanne E. Byrum CPC


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## cblack712 (Feb 28, 2012)

I will def get some more together and get them to you! I strugled with that one myself for a bit too until we started gearing for ICD-10 and I was sent to a workmens comp seminar.


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## ollielooya (Feb 28, 2012)

Thank you for your response.  I've posted this question in other forums in addition to AAPC and so far your answer is the only one that has supplied some specifics.  I'm surprised my questions haven't been asked before or received any additional answers describing that troublesome phrase.  I'm still at a loss as to understand what ICD9 is trying to instruct. ---Suzanne E. Byrum


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## cblack712 (Feb 28, 2012)

Not a problem - I will do whatever I can to help. I got slammed today so I didn't have the time to sit down and scrub out the reports for compliance, but I will get it to you!!


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## ollielooya (Feb 28, 2012)

Thank you for your willingness to share your expertise.  I do realize that you are doing this on your own time when you could be doing other things, and I'm very grateful that you are following thru with your offer to help.  I will be sure to pay it forward somehow, someway with others on this forum.  Again, thank you for your help.  ---Suzanne


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## cblack712 (Feb 29, 2012)

So here we go - I am going to post this here and send you an email to the yahoo account that you posted earlier so that you can have it!

NOTE TO ALL WHO MAY WISH TO POINT OUT THAT THERE ARE MISSING DX CODES --- I AM ONLY CODING THE E000.X CATEGORY AT THE VERY END I HAVE INCLUDED THE GUIDELINES FOR USING THOSE 4 CODES 

28 year old female sustained a blow to the head with brief loss of consciousness after falling from horse drawn carriage. Patient was a chaperone of her childs field trip and other parent chaperones reported to EMS when they arrived that patient was unaware of what was going on and seemed “really out of it”. 
E000.2 – Volunteer activity 
 --Same case however instead of it being a chaperone it was a teacher escorting her class during the school day.
E000.1 – B/C it was the teacher who would have been working at the time

 --Same case however instead of it being a teacher or chaperone it is a student. 
E000.8


45 year old male employee at the freight dock sustained significant injury when a packaging crate (approx 220lbs) fell from a top storage unit and trapped the patient between the crate and concrete flooring as he was taking inventory. 
E000.0
---Same case however --- fellow employee of patient indicates that the patient wasn't working that day. He was walking through the area to get to a portion of the dock that he liked to go and fish at and had his fishing rod in hand. 
E000.8 b/c patient was partaking in leisure activity off the clock

22 year old female rendered unresponsive with significant mental impairment   after being struck in head with what witnesses described as a 2x4 in the parking lot of Dollar General by unknown assailant. At this time patient is listed as “Jane Doe”  - A Witness to the assault of patient and notified EMS indicates that patient looks familiar and works  at the Dollar General however was unsure if she was working at the time- police were unable to locate identification and witness cannot recall her name. 
E000.9
This is coded with the E000.9 because we have a location, and an individual indicating that she worked there – but we do not know if she was shopping or maybe dropping something off or picking something up or working. 

---Same case – however witness indicates that the patient rang up his items a few moments before the attack and was taking trash out. 
E000.0 – b/c patient was working at the time of attack


Here are a few extras to remember when using the E000.X codes -- This is one of the prep steps that was initiated to help docs dictate more detailed for ICD-10, they are all about the dictation:

-E000.X Can never be used as a primary dx - and can only be used as a supplement to other E codes - if there is no code from E001.X - E999 then use of the E000.X is inappropriate. 

-E000.X Can NOT be used with E codes for adverse effects, late effects, misadventures or poisonings.  

-E000.9 Can NOT be used as a default when the patients status is not stated (i.e --female patient slipped while cleaning the bathroom --- we don't know if she was cleaning the bathroom at her work, for a friend or as part of her normal house cleaning therefore we should not be using a code from the E000.X category. 

-Civilian is considered someone receiving a paycheck for work that is not active duty military


Hope that helps some -- I am here if you need any more clarification. E codes can be challenging enough, but then to add another one that is "lacking" proper guidance in the guidelines is def a tough one.


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## ollielooya (Mar 1, 2012)

Carrie, this is a great help to students, beginning coders and refresher for the folks who use them.  As per my email to you this helped a lot, although  (as I told you)  feel that the E000.9 is somewhat redundant.  My personal opinion only!   IT's my hope that this thread will continue for a bit and that we can have a discussion of E codes!  ;-))
---Suzanne


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## saj402 (Nov 7, 2012)

I am still trying to get a grasp on the External status codes and found this post.  Very helpful but I am still confused on a scenerio that happens at home.

Patient tripped and fell on a hose at home and cut his lip.  Is there any External status code that would be assigned?  Most of the time that is all I get for documentation.


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