ED Coding and Reimbursement Alert

When reporting accidental injuries, poisonings and late affects of injuries that are evaluated in the ED, coders should remember to use the supplemental E codes listed in ICD-9-CM, when appropriate, to fully document the medical justification for the ED visit.

E codes are never listed as the primary diagnosis, because they only identify the circumstances of an accidental injury, states Jeri Leong, RN, CPC, a medical practice consultant and certified coding instructor in Honolulu, HI. But, the coder may use the E code, and often more than one E code, to fully describe circumstances or establish medical necessity.

For example, a child falls from a playground jungle gym and presents to the ED complaining of pain in her lower left arm. The physician evaluates the child and determines that the arm is only bruised, but not broken or sprained. He also evaluates the child for any other injury.

A diagnosis code for the chief complaint of arm pain (729.5) should be listed as the primary diagnosis. But, if this code were reported alone to a third-party payer, the E/M level for the workup might be downcoded because the diagnosis is not specific.

However, if this code were reported in addition to E884.0 (fall from playground equipment) and E849.4 (place for recreation and sport), the payer would have information justifying the ED physicians workup and, possibly, x-rays to rule-out a fracture or more severe injury.

E codes are very useful in reporting accident circumstances to third-party payers and many work-related or automobile-related insurers now require them, Leong adds.

The ICD-9 E codes are listed in under Supplementary Classification of External Causes of Injury and Poisoning. There is a tabular list of E codes in Volume 1 and an alphabetical listing in Volume 2.

These codes describe environmental events, circumstances and conditions of injuries, including circumstances surrounding accidental ingestions and poisoning or late effects of injuries, Leong explains.

As with the other ICD-9 codes, all E codes that are italicized should not be used as the primary E code reported, she adds. These codes merely identify the place of occurrence, such as E849.4 she states.

According to ICD-9, the main purpose of E codes is to statistically track the incidence of accidental injury. For example, the well-known statistic that most accidents happen in the home was obtained from through the use of E-code tracking. But, E codes do have reimbursement value as well.

E codes can clarify who is liable for the cost of treatment when an accident occurs, reads the 1999 edition of ICD-9-CM. Payors need this information to coordinate benefits correctly.