Pediatric Coding Alert

Tip: Never list E codes as primary diagnoses.

Accidents do happen--and when it comes to treating pediatric patients, they happen frequently. Round out your diagnosis coding for accidental injuries by adding 'E codes' to your ICD-9 roster, and you can speed up your claims processing.

When reporting accidental injuries, poisonings and late affects of injuries, you should remember to use the supplemental E codes listed in ICD-9-CM, when appropriate, to fully document the medical justification for the visit. E codes are not required, and are never listed as the primary diagnosis, because they only identify the circumstances of an accidental injury. However, you may use the E code, and often more than one E code, to fully describe circumstances or establish medical necessity.

Example: A child falls from a playground jungle gym and presents to the office complaining of pain in her lower left arm. You evaluate the child and determine that the arm is only bruised, but not broken or sprained. You also evaluate the child for other injuries and report a 99213 for the visit.

A diagnosis code for a contusion of the forearm (923.10) should be listed as the primary diagnosis. But some payers might question the E/M level for the workup because the diagnosis is not specific. However, if this code were reported in addition to E884.0 (Fall from playground equipment) and E849.4 (place for recreation and sport), the payer would have information justifying workup and, possibly, x-rays to check for a fracture or more severe injury.

Get to Know E Code Basics

The ICD-9 E codes are listed in under "Supplementary Classification of External Causes of Injury and Poisoning." There is a tabular list of E codes in Volume 1 and an alphabetical listing in Volume 2. These codes describe environmental events, circumstances and conditions of injuries, including circumstances surrounding accidental ingestions and poisoning or late effects of injuries.

According to ICD-9, the main purpose of E codes is to statistically track the incidence of accidental injury. For example, the well known statistic that most accidents happen in the home was obtained from through the use of E-code tracking. E codes do not change your reimbursement amount because they are considered "for informational purposes only" codes, but they can keep claims processing delays at bay because insurers may have fewer follow-up questions about your claims if they get a fuller picture of a patient's diagnosis due to your E code usage. Plus, in cases where your patient is injured by a moving car, either as a pedestrian, bike rider, orpassenger, you'll often have to deal with auto insurers, which may require E codes.

Don't forget: You should never report E codes in lieu of a diagnostic code to describe an injury, but E codes help the carrier understand how the patient was injured. If a patient was injured during circumstances where liability is in question, E codes will be essential.

Example: A nine-year-old patient is rappelling at a birthday party and the rope holding him breaks, causing the patient to fall to the ground, landing on his foot in a twisted position. The mother tells you that she wants the child checked for injuries, and says that if he is hurt, a lawsuit might be a possibility. You examine the patient and find that he has a dislocated toe but no other injuries.

In this example, you'll report 838.09 (Closed dislocation, other) as the primary diagnosis, followed by E004.1 (Rappelling) as your secondary code.

Get to Know Common Pediatric 'E' Codes

If you think E codes don't apply to you, consider these possibilities: Have you ever treated a patient for a dog bite? How about a bee sting? Or an allergic reaction to antibiotics? These are all covered in ICD-9's E code section. Keep the following common pediatric E codes in mind when you're coding your diagnoses going forward:

• E812.1 (Other motor vehicle traffic accident involving collision with motor vehicle, Passenger in motor vehicle other than motorcycle)
• E826.1 (Pedal cycle accident; Pedal cyclist) for a patient who falls off of his bike.
• E883.0 (Accident from diving or jumping into water [Swimming pool]) for a patient who gets hurt jumping into a pool
• E884.4 (Fall from bed)
• E885.2 (Fall from skateboard)
• E900.0 (Excessive heat due to weather conditions) for sunstroke
• E905.3 (Venomous animals and plants as the cause of poisoning and toxic reactions; hornets, wasps, and bees) for reactions to bee, hornet or wasp stings
• E906.0 (Dog bite)
• E917.0 (Striking against or struck accidentally by objects or persons; In sports without subsequent fall) if a patient is hit by a thrown ball or kicked during a sports game
• E920.4 (Accidents caused by cutting and piercing instruments or objects; Other hand tools and implements) if a patient is cut with a pair of scissors or a sewing needle
• E930.0 (Drugs, medicinal and biological substances causing adverse effects in therapeutic use; Penicillins) -- for adverse effects of correctlyadministered penicillin