Urology Coding Alert

Secondary diagnosis codes provide payers with additional details.

Although urology practices don’t see injured patients as frequently as certain other specialties, you’ll still find occasions when a patient’s condition occurs due to an external cause. When that happens, you should report a code from the V00.- (Pedestrian conveyance accident) through Y99.- (External cause status) range, if it’s appropriate.

Adding external cause codes to your claims allows you to more completely convey such details as the cause, intent, patient status, activity of the patient at the time of the event, place of occurrence, or other information to the payer, according to the 2023 ICD-10-CM Official Guidelines for Coding and Reporting. But before you add these critical codes to the patient’s record, there are a few things you need to know.

What Are External Cause Codes?

ICD-10-CM defines the external cause codes as those 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 include the following:

• Cause: V23.01XD (Electric (assisted) bicycle driver injured in collision with car, pick-up truck or van in nontraffic accident, subsequent encounter)
• Intent: Y07.01 (Husband, perpetrator of maltreatment and neglect)
• Place: Y92.003 (Bedroom of unspecified non-institutional (private) residence as the place of occurrence of the external cause)
• Activity: Y93.11 (Activity, swimming)
• 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 7^th-character codes A (…initial encounter), D (…subsequent encounter), or S (…sequela) as appropriate.

To master the use of these codes, check out a few key facts, along with urology-specific examples.

Tip 1: Use Them as Secondary Diagnoses

The 2023 ICD-10-CM Guidelines indicate that you can report as many external cause codes as necessary, but you should never report them as the primary diagnosis.

Example: Suppose a patient comes in with an injury to the urethra suffered while playing baseball. In this case, you would report S37.30XA (Unspecified injury of urethra, initial encounter) as your primary diagnosis.

For secondary diagnoses, you might consider submitting W21.03XA (Struck by baseball, initial encounter) or Y92.320 (Baseball field as the place of occurrence of the external cause).

In some cases, however, your payer may limit the number of external codes you can assign to any particular claim form. In these cases, you should report the code for the cause/intent most related to the principal diagnosis, per the guidelines. The provider may need to weigh in on which secondary diagnosis code is most closely related to the principal diagnosis, based on their professional opinion.

Tip 2: Report Place of Occurrence Code One Time Only (Usually)