Primary Care Coding Alert

3 steps will improve your pay
 
If you don't assign E codes when you file workers' compensation (WC) claims, you won't get squat.
 
"You should always include E codes with WC claims," says Tamara Hidalgo, CPC, a Presbyterian Medical Group auditor in Albuquerque, N.M. Payers process claims faster when they contain external causation or E codes, she says.

To speed payment for WC claims, coding experts offer the following advice on assigning E codes:

1. Use E Codes to Complete the Picture

You should assign E codes with WC claims to tell the payer what caused the patient's injury or illness, says Marvel J. Hammer, RN, BS, CPC, CHCO, principal of MJH Consulting in Denver. "Correct code assignment can mean prompt payment," she says.
 
Using E codes fosters reimbursement, Hidalgo agrees. Most payers request medical records with WC claims. Assigning E codes gives the insurer a clearer picture of the patient's accident. The extra information avoids delays and speeds claim processing, she says.

2. List Causes in Secondary Position

Make sure to link the E code as secondary or lower in box 24 E of the CMS-1500 form, Hammer says. You should never report E codes alone or sequence them as the first or primary diagnosis, she says.

Hammer offers the following WC example: A drill- press operator lacerates two fingers while operating a press. The injury does not cause tendon damage.

For the primary diagnosis, you should report 883.0 (Open wound of finger[s]; without mention of complication), Hammer says. To identify the injury's cause, you should assign E919.3 (Accidents caused by machinery; metalworking machines).

Here's another scenario to test your sequencing skill: A painter falls from a ladder and complains of wrist pain. The FP documents that the patient has normal range of motion, but in the medical decision-making the physician states, "Rule out sprain or strain, rule out fracture."

ICD-9 coding disallows reporting rule outs in the outpatient setting. When no definitive diagnosis is available, you should instead report the patient's signs or symptoms, Hammer says. Therefore, in the above example, you should report the patient's symptom, wrist pain (719.43, Pain in joint; forearm), for the primary diagnosis. For the E code, assign E881.0 (Accidental falls; fall on or from ladders or scaffolding; fall from ladder).

3. Focus on 5 E Code Sections

For WC claims, you will mainly use E codes from five sections, Hammer says. The most common WC injuries result from falls (E880.x-E888.x, Accidental falls ...). Patients may also present with accidental injuries from machines (E919.x, Accidents caused by machinery). Nurse and hospital workers are at risk for accidental needle sticks (E920.5, Accidents caused by piercing instruments or objects; hypodermic needle). Construction workers and movers often get work-related injuries from overexertion and strenuous movements (E927). "If a patient has new manifestations from an old injury, such as in the late 1980s, consider using a late effects code (E929.x, Late effects of accidental injury)," she says.

To simplify your E code selection, laminate and post this frequently used injury code chart.