Home Health ICD-9/ICD-10 Alert

When ICD-10 debuts in 2013, you'll have broader bandwidth for describing the external cause of a patient's injury or poisoning. And home health coders will be required to list external cause codes more frequently.

While E codes are the go-to code range when it comes to reporting external causes in ICD-9, ICD-10 external causes of morbidity codes can begin with V, W, X, or Y, says Trish Twombly, BSN, RN, HCS-D, CHCE, COS-C, director of coding with Foundation Management Services in Denton, Texas.

These ICD-10 codes describe:

• How the patient was hurt;
• Where he was when he was hurt;
• What activity he was doing when he was hurt; and
• The external cause status.

Now: As a home health coder, you're currently only required to list an E code when your patient has experienced the adverse affect of a drug or chemical -- whether it was used therapeutically or was a poisoning.

Change: Once we make the transition to ICD-10, you will need to report a code to describe how your patient was hurt whenever your patient's condition is the result of external causes.

Tip: The "where," "what," and "status" codes won't be required for home care. You'll only need to list a code to describe the "how."

The Table of Drugs and Chemicals in your ICD-10 manual will look much the same as it does in ICD-9 with a few differences. You'll see columns for:

• Poisoning, accidental;
• Poisoning, intentional self-harm;
• Poisoning, assault;
• Poisoning, undetermined;
• Adverse effect (This was therapeutic use in ICD-9); and
• Underdosing.

The underdosing category is new in ICD-10, Twombly says. We don't currently have an option for reporting the specifics when a patient is unstable due to underdosing.

Coding scenario: Your patient has hypertension. He has continued to experience elevated blood pressure while taking blood pressure medication. While assessing the patient, the nurse discovers he was taking his medication once daily instead of twice daily because of the cost of the drug. To code for this patient in ICD-10, Twombly suggests the following codes:

• I10 (Essential [primary] hypertension);
• T46.5x6D (Underdosing of other antihypertensive drugs, subsequent encounter); and
• Z59.8 (Other problems related to housing and economic circumstances).