Pediatric Coding Alert

Question: A patient fell at dance class and our pediatrician treated her for a concussion. The dance studio's insurer is asking our office for the external cause code. What is this?

New Jersey Subscriber

Answer: The code the insurer is looking for is E005.0 (Activities involving dancing and other rhythmic movement; dancing). E codes describe external causes of injuries or accidents.

ICD-9 2010 introduced "a fascinating set of codes for 'Activities' like E005.3 (... trampoline) or E007.5 (Activities involving other sports and athletics played as a team or group; soccer),"  notes Chip Hart, director of Physician Computer Company's (PCC's) Pediatric Solutions in Winooski, Vt. His favorites are E018.3 (Activities involving playing musical instrument; wind and brass instrument playing) and E019.1 (Activities involving animal care; milking an animal). As a Vermonter, he knows how important tracking dairy injuries is.

If you have children or a sibling, you can agree there was a need for injuries from activities involving roughhousing (E029, Other activity; roughhousing and horseplay), Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville. His other top E code picks describe injuries from activities involving Frisbee (E008.3, Activities involving other specified sports and athletics; Frisbee) and keyboarding (E011.0, Activities involving computer technology and electronic devices; computer keyboarding).

When reporting E codes, remember these guidelines:

• You should never bill an E code as your primary diagnosis.

• Always list the E code(s) last.

• To fully explain each cause, you may need to assign more than one E code. For instance, in your example, you would also indicate that the concussion (such as 850.0, Concussion; with no loss of consciousness) was from a fall (for example, E885.9, Fall from other slipping, tripping, or stumbling).

-- Information and/or answers to You Be the Coder and Reader Questions provided by Nancy Bishof, MD, a private-practice pediatrician in Lexington, Ky.; Chip Hart, director of PCC's Pediatric Solutions in Winooski, Vt.; Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, consulting manager for Pershing, Yoakley and Associates in Clearwater, Fla. and Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville.