Medicare Compliance & Reimbursement

Tip: Look to the 7th digit for injury clarification after a flood.

If you’re worried about coding procedures after a hurricane, you’re not alone. To ensure your claims submissions are spot on, make sure you don’t miss the release of the new 2019 ICD-10-CM Official Guidelines for Coding and Reporting.

Update: The 2019 guidelines add new section I.B.19 in to the “General Coding Guidelines” section, which specify how you should code healthcare encounters during a hurricane’s aftermath. Take a look at the following external cause code rules to address these disasters.

Rule 1: You should report external cause of morbidity codes to identify what caused the patient’s injuries as a result of the hurricane, per the guidelines. However, never report an external cause code as a patient’s principal diagnosis. Instead, you should sequence the correct injury code before an external cause code. Pertinent details that external cause codes describe include the cause of the injury; the intent; where the injury occurred; the patient’s activity at the time of the injury; and the patient’s status (whether civilian or military).

Don’t miss: In the aftermath of a hurricane, the guidelines consider a healthcare setting “any location where medical care is provided by licensed healthcare professionals.”

Rule 2: When it comes to sequencing, codes for hurricanes and other cataclysmic events should take priority over external cause codes, per the guidelines. So, you should sequence cataclysmic event external codes before other external cause of injury codes.

Exception to the rule: Child and adult abuse and terrorism external cause codes should take priority over all other external cause codes, including cataclysmic events.

Always report as many external cause codes as needed to fully describe each cause. If a patient sustains an injury as a direct result of the hurricane, report the correct code for his injuries, followed by X37.0XX- (Hurricane) (with the appropriate 7th character A, D, or S) and include any other applicable external cause of injury codes. Code X37.0XX- includes any injuries a patient receives as the result of flooding caused by a levee breaking related to the hurricane.

Important: You should report X38.XXX (Flood) (with the appropriate 7th character) if the patient’s injury was caused from flooding resulting directly from the storm. However, do not report X36.0XX- (Collapse of dam or man-made structure causing earth movement) when the hurricane causes the collapse. Instead, you should only report X36.0XX- for collapses of man-made structures due to earth surface movements, not for storm surges caused by hurricanes.

Rule 3: If a patient sustains an injury that did not result directly from the hurricane, then you should report the correct external cause code to describe the injury’s cause, but do not report X37.0XX-. However, if it’s not clear whether the patient’s injury was a direct result of the hurricane, you can assume the injury was due to the hurricane and report X37.0XX-, per the guidelines, along with any other applicable external cause of morbidity codes.