Podiatry Coding & Billing Alert

Know when you should — and when you have to —report them.

If you’re not sure if reporting a code from Chapter 20, External Causes of Morbidity (V00-Y99) is mandatory or optional, there’s good reason for your confusion.

It stems from the ICD-10-CM guideline I.C.20 for reporting external cause, which tells you “there is no national requirement for mandatory ICD-10-CM external cause code reporting. Unless a provider is subject to a state-based external cause code reporting mandate or these codes are required by a particular payer, reporting of ICD-10-CM codes in Chapter 20, External Causes of Morbidity, is not required.”

The guideline raises all sorts of questions surrounding the what, when, how, and why of external cause reporting. So, we asked some expert coders to answer the questions, and here’s what they told us.

What Are External Cause Codes?

ICD-10-CM guideline I.B.19.a tells you the external cause codes are codes that “capture how the injury or health condition happened (cause), the intent (unintentional or accidental; or intentional, such as suicide or assault), the place where the event occurred, the activity of the patient at the time of the event, and the person’s status (e.g., civilian, military).”

Examples of external cause codes that describe these five factors that you might use in a podiatry setting include the following:

• Cause: V00.11- (In-line roller-skate accident)
• Intent: Y00.- (Assault by blunt object)
• Place: Y92.003 (Bedroom of unspecified non-institutional (private) residence as the place of occurrence of the external cause)
• Activity: Y93.66 (Activity, soccer)
• Individual’s Status: Y99.8 (Other external cause status) (Includes individuals involved in hobby or leisure activities, including amateur recreation or sports).

Remember to go to seven characters when required. Many external cause codes must be seven characters in length. This means you must use one or more X-character extensions when necessary, and 7th character codes A (initial encounter), D (subsequent encounter), or S (sequela) as appropriate.

Why, and When, Must I Report Them?

While ICD-10-CM guidelines for reporting external cause state, in part, that “there is no national requirement for mandatory ICD‐10‐CM external cause code reporting,” the guidelines go on to note that external cause codes may be required when subject to “a state‐based … reporting mandate” or by “a particular payer.”

State example: The Louisiana Department of Health and Hospitals require coders in that state to report “a valid External Cause-of-Injury Code” whenever they report trauma-related codes from the Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes (S00.00XX– T88.99XX) range (Source: http://www.fortherecordmag.com/ archives/0617p24.shtml).

Payer liability: At the payer level, there are also good reasons for using the codes. “The use of the external cause codes is necessary to ensure accurate billing and application of benefits,” explains Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/credentialing/auditing/ coding coordinator at County of Stanislaus Health Services Agency in Modesto, California. “These codes will allow an insurance carrier or billing department to clearly see when there may be a third-party payer involved. In the case of benefits, it may affect the patient liability, as it could affect the application of the deductible or co-insurance allowance,” Johnson adds. For instance, using an external cause code to denote a patient’s injury is due to an auto accident will let the patient’s health insurance carrier know that an automobile insurance carrier (e.g. the patient’s or that of another driver) may be liable for the cost of the services.

If I’m Not Required to Report Them, Why Should I?

Put simply, you should report external codes for two very good reasons. First, they have tremendous meaning for governments and agencies at the local, state, and national level. The codes provide “the opportunity to report enhanced detail [and] improve the process of data collection for researchers and policy makers,” according to Evan M. Gwilliam, writing in the American Academy of Professional Coders’ (AAPC) blog (https://www.aapc.com/blog/27301-icd-10-cm-external-cause-codes-tell-the-whole-story/).

Second, the external cause codes can support practice-based research and quality improvement, too. They “can be useful for understanding the conditions you’re treating, as quality-improvement opportunities might reveal themselves,” according to Jan Blanchard, CPC, CPMA, pediatric solutions consultant at Vermont-based PCC. For example, a podiatrist could use codes like V00.11- to track skating accidents and use that information to education patients.

Are There Times When I Should Never Report Them?

Yes. According to two more ICD-10-CM guidelines I.C.20.b and 20.c, you should never use a place of occurrence Y92.- (Place of occurrence of the external cause) or an activity code Y93.- (Activity codes) if another entity has already reported the place or activity. For example, if your podiatrist is seeing a patient for follow-up care after the patient has already been treated at an emergency department (ED) or an urgent care facility, you do not need to report a place of occurrence external cause code, as these codes are use “only once, at the initial encounter for treatment.”

And remember: Per guideline I.C.20.a.6, you should never use an external cause code as a principal, or first-listed, diagnosis. And while guideline I.C.20.a.4 tells you to assign as many external cause codes as necessary, you should always follow guidelines I.C.20.f for sequencing multiple codes. Here, you are told that “external cause codes for transport accidents take priority over all other external cause codes except cataclysmic events, child and adult abuse and terrorism.”