ED Coding and Reimbursement Alert

The ICD-9 2010 section that got the heaviest attention was the E codes, whose exponential expansion offers you much more specific codes when it comes to describing external causes of injury or poisoning.

This dense E code addendum is just a product of the exciting new ways people are now able to injure themselves, says Denae M. Merrill, CPC, CEMC, HCC coding specialist at The Coding Source and owner of Merrill Medical Management in Saginaw, Mich.

"New technologies, new extreme sports, new war equipment, the list goes on ... and so do the possibilities of injury, which means the E codes must try to keep up," Merrill says.

Among the dozens of new E codes are:

• E001.0 -- Activities involving walking, marching, and hiking

• E002.7 -- Activities involving surfing, windsurfing, or boogie boarding

• E007.0 -- Activities involving American tackle football

• E013.0 -- Activities involving personal bathing and showering

• E013.4 -- Activities involving floor mopping and cleaning.

While you may occasionally use V codes as your primary diagnosis, you should never use E codes as primary diagnoses. These codes are not for describing injuries or diseases; E codes illustrate the circumstances surrounding an injury or disease.

Example: An 11-year-old patient reports to the ED with a swollen right ankle. The patient's mother reports that he suffered the injury during a baseball game. The nonphysician practitioner (NPP) examines the ankle, which is swollen but shows no sign of bruising or fracture. The NPP diagnoses an ankle sprain, and recommends ice and ibuprofen as treatment. Notes indicate a level-two E/M service.

On the claim, you should report the following:

• 99282 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity ...) for the E/M

• 845.00 (Sprains and strains of ankle and foot; ankle; unspecified site) appended to 99282 to represent the sprain

• E007.3 (Activities involving baseball) appended to 99282 to represent the cause of the injury.