Radiology Coding Alert

Do activity codes provide valuable research data? Find out.

Using the activity codes listed in the ICD-10-CM code set help you tell the whole story of a patient’s injury. From the ice to the slopes, there are several ICD-10-CM activity codes dedicated to winter activities that let you report what the patient was doing at the time of the injury.

Read on to learn more about winter sports activity codes.

Document How the Injury Occurred

Carefully reporting your patients’ diagnoses are important, and recording the cause of those injuries, aches, pains, and sprains if the provider’s documentation lists the reason offers benefits outside of your practice. Chapter 20: External Causes of Morbidity (V00-Y99) of the ICD-10-CM code set includes several codes designated for activities that may result in injuries and other adverse conditions.

Section I.C.20.c in the ICD-10-CM guidelines states, “Assign a code from category Y93, Activity code, to describe the activity of the patient at the time the injury or other health condition occurred.” This means if the provider records what the patient was doing when the injury occurred, you can report the appropriate activity code from the Y93 (Activity codes) code family.

Important: If the documentation does not call out a specific activity, the guidelines instruct you not to assign Y93.9 (Unspecified activity) in your report.

Land Your Ice Skating Coding

Scenario: A 15-year-old patient comes into your radiology practice to receive X-rays of their left ankle. The physician documents the patient twisted their ankle during a trick attempt while figure skating. The radiologist captures three views of the patient’s left ankle and diagnoses them with a left ankle sprain.

When you’re coding this encounter, you’ll use CPT^® code 73610 (Radiologic examination, ankle; complete, minimum of 3 views) to document the X-rays. To code the ankle sprain, you’ll start with Sprain, ankle in the Alphabetic Index of the ICD-10-CM code set, which provides you with S93.40 (Sprain of unspecified ligament of ankle). This parent code carries a 6^th character required icon, so you’ll need to choose the code that applies to the left ankle. This code, S93.402 (Sprain of unspecified ligament of left ankle), also carries a 7^th character required icon, which requires the letter A added to the end of the code to show this was the initial encounter. Your diagnosis code will be S93.402A (Sprain of unspecified ligament of left ankle, initial encounter).

Additionally, the documentation indicates the patient sprained their ankle while figure skating. With this information, you can start with parent code Y93, which features a 4^th character required icon. Code Y93.2 (Activities involving ice and snow) carries a 5^th character required icon that leads you to Y93.21 (Activity, ice skating).

Code Y93.21 also includes the following additional synonyms:

• Activity, figure skating (singles) (pairs)
• Activity, ice dancing

Excludes1 note: Code Y93.21 carries an Excludes1 note that specifies you cannot assign the code to an ice hockey injury. Instead, you’ll use Y93.22 (Activity, ice hockey) to code an injury that occurred while the patient played ice hockey.

Perfect Your Concussion Coding Skills

Scenario: A 26-year-old male patient’s friends bring him into the emergency department with headache, neck pain, dizziness, and nausea after snowboarding during the day. His friends say he experienced a hard fall while going down a steep hill, hit his head on the ground, and lost consciousness for about five minutes. The patient claims he wore a helmet during the activity since he’s experienced multiple concussions while snowboarding before. The physician performs a physical examination and orders CT scans to check for internal damage. After evaluating the results, the doctor diagnoses him with a concussion with loss of consciousness.

In this scenario, the patient presented with symptoms consistent with a concussion. The physician diagnosed the patient with a concussion with loss of consciousness, as the patient’s friends mentioned he lost consciousness for about five minutes. Additionally, the patient visited an emergency department, which establishes the visit as an initial encounter. This information leads you to assign S06.0X1A (Concussion with loss of consciousness of 30 minutes or less, initial encounter) for the patient’s diagnosis.

The patient also mentioned he has a history of concussions. You will code the patient’s personal history of concussions using Z87.820 (Personal history of traumatic brain injury). Lastly, the patient explained his injury occurred while snowboarding, which you can select from the Y93.2 code family. You’ll assign Y93.23 (Activity, snow (alpine) (downhill) skiing, snowboarding, sledding, tobogganing and snow tubing) to explain what the patient was doing at the time of the injury.

Reporting Activity Codes Provides Crucial Data

Activity codes are beneficial to your report, but “there is no national requirement for mandatory ICD-10-CM external cause code reporting,” says Autumn Hull, CPMA, CPC, CEMC, CPAR, Supervisor of Professional Audit Services of Pinnacle Enterprise Risk Consulting Services (PERCS) in Five Points, Alabama. Assigning the code in your report depends on the payer’s preferences. “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 is not required,” Hull adds.

Reporting activity codes does have a benefit, even though they’re not required for your claim. Using the information given to you in the provider’s documentation helps paint the patient’s clinical picture and can assist in proving medical necessity. In the snowboarder scenario above, if the physician wanted to order a CT based on the symptoms provided by the patient, they may have difficulty proving the necessity. However, knowing the patient was snowboarding earlier that day and has a personal history of concussions helps back up the claim.

Additionally, documenting activity codes provides important data to help administrators evaluate the effectiveness of current policies and programs. Plus, the statistics from the codes determine the need for new prevention programs. “Providers are encouraged to voluntarily report external cause codes, as they provide valuable data for injury research and evaluation of injury prevention strategies,” says Hull, and the external cause of injury codes describe what occurred that led to the patient’s injury, which contribute to injury surveillance efforts.