ICD 10 Coding Alert

Utilize external codes to provide more context.

External cause codes V00- (Pedestrian conveyance accident) through Y99- (External cause status) can be vital to your claims because they show the bigger picture of patient’s health conditions.

Check out the following three hints to ensure you know how to properly report external cause codes in your practice.

Hint 1: Go Above and Beyond by Using External Cause Codes

There are no national requirements that mandate you to report external cause codes; however, providers are still encouraged to voluntarily report these codes because they “provide valuable data for injury research and evaluation of injury prevention strategies,” per the ICD-10 Official Guidelines for Coding and Reporting.

“I always recommend including external cause codes when applicable to the treatment being rendered,” adds J. Paul Spencer, CPC, COC, senior compliance consultant for Doctors Management, LLC in Knoxville, Tennessee. “I wish I could say that insurance companies treat all claims equally, and that with the minimal information required, all claims would be paid on first pass. Having spent over six years in the insurance industry, I know that not to be the case.”

Spencer goes on to explain his point of why reporting external cause codes is important: “Including this information from the initial claim gives the provider the first chance to submit a description of the external cause and can also provide a layer of argument for future appeals in cases where payment is continually denied or pended for this information. In the end, it’s a display of a good faith effort by the provider to voluntarily provide this information.”

Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California, agrees with the importance of reporting external cause codes.

“The use of the external cause codes is necessary to ensure accurate billing and application of benefits,” Johnson explains. “These codes will allow an insurance carrier or billing department to clearly see when there may be a third-party payer be involved. In the case of benefits, it may affect the patient liability on account as it could affect the application of the deductible or co-insurance allowance.”

Important: While there is no current national requirement for mandatory ICD-10-CM external cause code reporting, some payers and/or states do require them, cautions Cynthia A. Swanson, RN, CPC, CEMC, CHC, CPMA, senior manager of healthcare consulting for Seim Johnson in Omaha, Nebraska.

So, you should always check with your payers and/or know if your state requires you to report external cause codes.

Hint 2: Don’t Use External Cause Code as Primary Diagnosis

You should never sequence an external cause code as the first-listed or principal diagnosis, according to the guidelines. Instead, you should use these external cause codes as secondary codes to provide additional information. External cause codes can tell you the following helpful information:

• The cause, which explains how the injury or health condition happened. For example: W55.12XA (Struck by a horse, initial encounter).
• The intent, whether the injury or health condition was unintentional or accidental or intentional. For example: X81.0XXA (Intentional self-harm by jumping or lying in front of motor vehicle, initial encounter).
• The place where the event occurred. For example: Y92.322 (Soccer field as the place of occurrence of the external cause)
• The activity of the patient at the time of the event. For example: Y93.18 (Activity, surfing, windsurfing and boogie boarding).
• The patient’s status. For example: Y99.8 (Other external cause status).

Example: A child sustains minor injuries when he falls from a tree while playing. After receiving medical attention in the emergency department for cuts and bruises, the child continues to show signs of dizziness with drowsiness. Concerned that the patient may have head injuries, the neurosurgeon on staff admits the patient to observational status. In this case, the surgeon may include dizziness/giddiness (R42) and drowsiness (R40.0), among others, as the primary diagnoses, with W14.XXXA (Fall from tree, initial encounter) as a secondary diagnosis, linked to the primary procedure code (e.g., 99219, Initial observation care, per day, for the evaluation and management of a patient ...).

Hint 3: Utilize External Cause Codes for Injuries, Conditions, or Diseases

Although external cause codes are most applicable to injuries, you can also report them with conditions like infections or diseases due to an external source, and other health conditions, like a heart attack that happens during strenuous physical activity, according to the guidelines.

Bottom line: You can report external cause codes with any code in the range A00.0 (Cholera due to Vibrio cholerae 01, biovar cholerae) through T88.9XXS (Complication of surgical and medical care, unspecified, sequela) and Z00- (Encounter for general examination without complaint, suspected or reported diagnosis) through Z99- (Dependence on enabling machines and devices, not elsewhere classified) that represents a health condition due to an external cause.