Neurosurgery Coding Alert

Question: What are "E" codes and when should they be used?

Tennessee Subscriber

Answer: E codes are secondary diagnosis (ICD-9) codes that define "external causes of injury" and thereby provide more detailed information concerning the nature or origin of a patient's injury or condition. An E code might 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 barroom brawl). E codes do not affect reimbursement, but the facts they supply can help to support a claim and 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 accident involving collision with train" but requires that a fourth digit be appended to identify the victim of the collision, whether a motor vehicle driver, bicyclist, pedestrian, etc.

As is 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 sustains 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 continues to show signs of dizziness, sleepiness and disorientation. 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 (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 evaluation and management 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. 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 is primarily responsible for a claim.