Wiki E Codes Question

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Dellahg

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Good morning,

I am currently working in a local GP, and this is my first position as a medical biller/coder after receiving my Associate's Degree in August 2013.

I have a question regarding E codes usage. I know you are to use the E codes to further explain the extent of an injury, poisoning, etc. A new patient came in to get treated for injuries that she received in a motorcycle accident in mid-October. She fell off the motorcycle. At the time of the accident, they never filed a claim with their car insurance company. I was advised not to code the E codes as the payer will decline payment because they will say it should have been a car insurance claim.

Since E codes further explain the injuries and the guidelines state to use them, I cannot understand why I would not use them.

Looking for some guidance on this issue.

Thank you!
 
E codes

I always use E codes to identify an injury. However, coding guidelines state E codes 'may be used' so you are ok to not use it if you choose. In your case, the patient's health insurance could deny the claim if they see an E code but I believe just the injury diagnosis would cause this as well. Typically, health insurance carriers will direct a patient to file the claim on their automobile insurance policy first when the injury is due to an MVA.
 
You should always use an Ecode when necessary, especially if you are using any of the 800-900 ICD-9 codes, those all require an E code. Also, it is illegal to knowingly leave out codes just to the get the visit paid.

If the injury is a result of a car accident and they are not submitting it to the auto-insurance, it will probably get denied, but that is not your problem, your job responsibiltiy is to code accurately and legally. So if the doctor documents injury due to car accident, you must code as such.
 
One thing I would question is if this is the first visit for the issue being addressed or a subsequent visit. This is because E codes are only reported one time at the initial visit for the injury, so if this is a subsequent visit you wouldn't code the E codes anyways.
 
E Codes

To all,

Thank you so very much for your quick responses to my question! I really appreciate the assistance.

This is an initial visit and not a subsequent one.

Again, thank you!
 
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