Neurology & Pain Management Coding Alert

Question: What are E codes, and when should I use them?

Tennessee Subscriber

Answer: E codes are secondary diagnosis (ICD-9) codes that define "external causes of injury" and thereby provide more detailed information on the nature or origin of a patient's injury or condition. An E code can specify that a patient's injury was caused by an auto accident, industrial machinery or even a lightning strike, for instance, or that the patient had an adverse reaction to a drug or medication. These codes can also inform carriers if an injury was self-inflicted (a suicide attempt, perhaps) or the result of assault (such as lacerations suffered during a bar-room brawl). E codes do not affect reimbursement, but the facts they supply can help to support a claim and/or may prevent suspension of a claim for "additional information."

Like other diagnosis codes, E codes should be reported to the highest level of specificity, and many codes require a fourth digit. For example, E810 specifies "Motor vehicle traffic accident involving collision with train" but requires a fourth digit to identify the victim of the collision, whether a motor vehicle driver, bicyclist, pedestrian, etc. As is also true of other diagnosis codes, E codes are compiled both alphabetically and by tabular list in the ICD-9 manual, and coders should double-check all entries from the alphabetical listing with the tabular lists to be sure the correct code is applied.

E codes are never the primary diagnosis. Always list the E codes last in a series of diagnoses linked to the primary procedure. If applicable, more than one E code may be used.

For example, a patient suffers minor injuries on the job after falling from a ladder while painting a house. After receiving medical attention in the emergency department for cuts and bruises, the patient still exhibits signs of dizziness, sleepiness and disorientation. Concerned that the patient may have head injuries, the neurologist on staff admits the patient to observational status. In this case, the neurologist may include dizziness (780.4) and drowsiness (780.09), among others, as the primary diagnoses, with E881.0 (Fall from ladder) linked to the primary procedure code (e.g., 99219, Initial observation care, per day, for the E/M of a patient ) as a secondary diagnosis.

Several states have mandated E codes in hospital billing, but in most outpatient cases E codes are not required, and CMS has not yet added a specific space for E codes on the CMS-1500 form. The most important use of E codes for most physician practices is when dealing with workers' compensation claims (as in the example above) or, in some cases, auto accidents. By providing detailed information about the nature of a claim and/or the circumstances of an accident, E codes help to determine if Medicare, workers' compensation, or a patient's private auto or health insurance may be responsible for primary payment of a claim.

Note: For easier referencing of E codes, consult Appendix E, "List of Three-Digit Categories." This appendix is a collapsed view of the tabular volume including V and E codes. You can look at all of the E-code categories on fewer than two pages and know where to go in the tabular volume quickly.