MDS Alert

Question: After looking through the external cause codes in the ICD-10 manual, I was a little confused. How do I really understand sequencing these codes, just out of curiosity?

Iowa Subscriber

Answer: You should use external cause codes as secondary codes to provide additional information. You should never sequence an external cause code as the first-listed or principal diagnosis, according to the ICD-10 Official Guidelines for Coding and Reporting.

External cause codes can tell you the following helpful information:

• Cause: Explains how the injury or health condition happened. For example: A resident tripped, fell, and hit his head on a chair — W01.190- (Fall on same level from slipping, tripping and stumbling with subsequent striking against furniture).
• Intent: Explains whether the injury or health condition was unintentional, accidental, or intentional. For example: The resident accidentally suffered a burn after using tap water that was too hot — X11.1- (Contact with running hot water out of tap).
• Place: Explains the place where the event occurred. For example: The resident broke her ankle in while taking a walk in the garden of the nursing home — Y92.126 (Garden or yard of nursing home as the place of occurrence of the external cause).
• Activity: Explains the activity of the resident at the time of the event. For example: The resident suffered a laceration from metal knitting needles while knitting — Y93.D1 (Activity, knitting and crocheting).
• Status: Explains the resident’s status. For example: Y99.8 (Other external cause status).