ED Coding and Reimbursement Alert

Question: With multiple diagnoses and E codes, is the E code listed after the diagnosis it pertains to, or is it listed at the end of all the diagnosis codes on the HCFA-1500 claim form?

Kathy Jones
Oroville, Calif.

Answer: The most important coding rule to keep in mind when using E codes is that they can never be the primary or only diagnosis code for a service. E codes are used as descriptors for the primary diagnosis codes.

They describe the type of accident, place of occurrence or cause of injury. E codes should be listed on the HCFA form after any applicable ICD-9 codes assigned to each individual service. As a general rule, list E codes last on the HCFA form.

E codes were created to classify environmental events, circumstances and conditions as the cause of poisoning, injury and other adverse effects. By using E codes together with ICD-9 codes in diagnosis coding, the provider is able to send a more detailed claim to the carriers for payment.

E codes are important because they can give details of accidents to an insurance carrier (such as workers compensation, auto accident, liability, etc.).

Some of the major categories of E codes are:

1. poisoning and adverse effects of drugs;
2. accidental falls;
3. transport accidents;
4. assaults or purposely inflicted injury;
5. late effects of accidents, assault or self-injury;
6. accidents caused by fires and flames;
7. accidents due to natural and environmental
factors; and
8. suicide or self-inflicted injury.

Please keep in mind that there may be occasions when multiple E codes may be necessary to describe the situation. One fact to remember in regard to listing multiple E codes is that those for child or adult abuse take priority over all other E codes.

The source for this Reader Question is Cindy McMahan, CPC, SVA Consulting, Albany, Wis.