Pulmonology Coding Alert

Find out how E codes help insurance companies on injury prevention and safety issues.

If you report injuries or poisonings, then you should be familiar with E codes. But before turning to these codes, make sure you keep in mind these 3 warnings that'll prevent your claim from getting tripped up by a denial.

1. Don't Lose E Codes' Purpose

E codes indicate the external causes of injuries and poisonings as well as the adverse effects of drugs and substances. They are considered special ICD-9 diagnosis codes which you can use generally to report accidents, injuries or diseases. You can report E codes in conjunction with regular ICD-9 codes.

Don't do this: You should never report E codes as your primary code since they only indicate the cause of injury/poisonings and NOT the resulting injury/condition. Always report E codes in addition to a numerical ICD-9 code that describes the injury itself. It may be necessary to assign more than one E code to fully explain each cause.

2. Be Specific About Your E Codes

Improving E code reporting can benefit auto insurance companies, disability insurers, health insurance plans, public payers, health care purchasers, employers, businesses, labor unions, schools and other entities interested in injury prevention and safety issues. But does it provide too much "up-front" information about the patient's behavior/lifestyle?

Consider the example of the patient who is admitted to the ICU for acute respiratory distress related to an unintentional narcotic overdose. If correctly reported, the diagnoses on the claim form would appear as 518.82 (Other pulmonary insufficiency not elsewhere classified), 965.09 (Poisoning by other opiates and related narcotics), and E850.2 (Accidental poisoning by other opiates and related narcotics). However, in reality only 518.82 gets reported since the physicians and billers are less familiar with the use of E codes and their implications.

3. Take More Risks Reporting Certain E Codes

There are E codes for reporting surgical mishaps, including:

Although you could bill these codes should the need arises, you would want to keep hoping you may never have to be face-to-face with these "need." These two new codes describe situations that are considered "never" events, meaning they represent surgical mistakes that should never happen.

Risk: Adding E876.6 or E876.7 to a claim ensures "that you will not get paid and may also add malpractice exposure," says Marcella Bucknam, CPC, CCS-P, CPCH, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians and Children's University Medical Group Compliance Program. You would want to discuss the decision to use these codes with your physician, quality and safety officer, and legal entity -- and make sure you have a full understanding of the implications, as well as the policies in place for preventing these types of errors, Bucknam adds.

Check out some of the other "wrong" entries listed in the 2010 ICD-9-CM Alphabetic Index.

Each of these "wrong surgery" E codes also carry a "wrong surgery edit". More specifically, procedures are flagged as not reasonable or necessary and will be automatically denied for payment. Providers should not try to bill insurance for these services, and should immediately look to legal counsel for appropriate actions.