Pediatric Coding Alert

Question: Is it important that I use the E codes? Insurers keep rejecting claims that contain the codes.


California Subscriber

Answer: Yes, you should continue to submit claims with E codes (E800-E999). Although the codes aren't payment codes, they explain the "environmental events, circumstances and conditions" that caused the injury, states the ICD-9-CM 2005 Expert manual.

Correct coding requires you to report this added information. E codes are part of the ICD-9 system, which instructs you to code an encounter to the highest specificity possible.

Agencies also use this supplemental information for statistical purposes. E codes help public-health officials plan prevention programs, and indicate, with diagnosis codes, a classification system for injuries.

If an insurer, such as California Blue Cross Blue Shield (BCBS), routinely rejects claims containing E codes, you'll have to do some extra work to obtain payment. Here's how:

1. Submit a paper claim, rather than an electronic claim.

2. Include chart notes.

Coding example: A 5-year-old girl falls from the monkey bars on the school playground and cuts her lower leg. The pediatrician determines that the wound does not warrant stitches, staples or tissue adhesive and instead closes the laceration with Steri-strips.

You should report the appropriate E/M service, such as 99213, depending on the level of history, evaluation and medical decision-making the physician performed while evaluating the trauma and repairing the wound. Link the E/M code to a primary diagnosis of 891.0 (Open wound of knee, leg [except thigh], and ankle; without mention of complication) and a supplementary diagnosis of E884.0 (Other fall from one level to another; fall from playground equipment).