Eli's Rehab Report

Question: I know that we're supposed to use E codes for injury claims, but our insurers keep rejecting claims that contain E codes. Can we withhold the E codes from these insurers?


California Subscriber

Answer: No. You should continue to submit claims with E codes (E800-E999) in addition to your primary diagnoses when appropriate. Although the E codes aren't payment codes, they explain the "environmental events, circumstances and conditions" that caused the injury, states the ICD-9 manual. Therefore, you should never report an E code as your primary diagnosis, but you should instead list it after the main diagnosis.

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

Agencies also use this supplemental information for statistical purposes. The 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, 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 submitting an electronic claim.

2. Include chart notes.

Coding example: A 5-year-old girl falls from the monkey bars on the school playground and dislocates her hip. Following treatment with a surgeon, the patient is referred to a physical medicine and rehab practice for one month of physical therapy to help her walk properly following the injury. 

You should report the appropriate PT service, such as 97116 (Therapeutic procedure, one or more areas, each 15 minutes; gait training [includes stair climbing]). Link the PT code to the appropriate ICD-9 code, such as 719.55 (Stiffness of joint, not elsewhere classified, pelvic region and thigh) and a supplementary diagnosis of E884.0 (Other fall from one level to another; fall from playground equipment).