Radiology Coding Alert

Question: Which ICD-9 codes should I report for an ankle x-ray for a patient with injury-related pain? The physician documented soft-tissue swelling.

Oregon Subscriber

Answer: You should code the specific injury type if documented. For example, an ankle sprain may merit 845.00 (Sprains and strains of ankle and foot; ankle; unspecified site).

If the provider documents an injury of unspecified type, report the appropriate code from category 959.x (Injury, other and unspecified), such as 959.7 (... knee, leg, ankle, and foot).

If there is documentation of pain but no documentation of injury, code the pain. For example, 719.47 (Pain in joint; ankle and foot) may be appropriate for ankle pain.

The soft-tissue swelling is a nonspecific observation that might or might not be clinically significant. If there are no definitive findings, code the presenting symptom rather than the swelling.

Depending on the payer, you may also need to include applicable E codes, which describe external causes of injuries or accidents. They range from the common (E880.9, Fall on or from other stairs or steps) to the obscure (E847, Accidents involving cable cars not running on rails). Basically, E codes can help you explain to payers how an injury happened.

Pointer: E codes do not change your reimbursement amount because they are for information only. You should never report E codes in lieu of a diagnostic code to describe an injury, but E codes help the carrier understand how the patient was injured. You should never report an E code as your primary diagnosis. You should instead list it after the main diagnosis.

Workers' comp: E codes also support the work-related nature of certain injuries to differentiate workers' compensation (WC) care from non-WC care. Although the E codes won't establish medical necessity, they explain the "environmental events, circumstances and conditions" that caused the injury, according to the ICD-9 manual.

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.