Wiki External Cause codes

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JVILLAS

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A child is evaluated for a swollen right hand after being bitten by mosquitos.

W57.XXXA INCORRECT
S60.561A CORRECT

What is a good way to explain to a provider why they can't use the W code as primary. They want to know the difference and though I know its an external cause what is the best way to explain the difference and why the S code should be used. if I states its an external cause code they are not going to understand me.

Thanks in advance

Jennifer, CPC
 
JVILLAS said:
A child is evaluated for a swollen right hand after being bitten by mosquitos.

W57.XXXA INCORRECT
S60.561A CORRECT

What is a good way to explain to a provider why they can't use the W code as primary. They want to know the difference and though I know its an external cause what is the best way to explain the difference and why the S code should be used. if I states its an external cause code they are not going to understand me.

Thanks in advance

Jennifer, CPC
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There's an actual ICD-10-CM guideline that prohibits it.

AAPC 2024 ICD-10-CM Expert, p. 1225,
Chapter-Specific Coding Guidelines

I.C.20. Chapter 20: External Causes of Morbidity (V00-Y00)

a. 6) External cause code can never be a principal diagnosis.
An external cause code can never be a principal (first-listed) diagnosis.
Click to expand...
 
Thank you and I as a coder understand that. I was looking for a way to explain it to a provider in simpler terms. The W and S code which the wording is similar. I like to teach the provider and show examples so they understand themselves.
 
JVILLAS said:
Thank you and I as a coder understand that. I was looking for a way to explain it to a provider in simpler terms. The W and S code which the wording is similar. I like to teach the provider and show examples so they understand themselves.
Click to expand...

W57.XXXA specifies the mechanism of injury (“bitten or stung by...”) whereas S60.561A specifies the injury itself (“insect bite”).

The external cause-of-injury codes are the ICD codes used to classify injury events by mechanism and intent of injury.
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https://www.cdc.gov/nchs/injury/injury_matrices.htm

The provider is not treating the mechanism of injury; the provider is treating the injury.

When you specify your CPT and/or HCPCS Level II codes on the CMS Form 1500 (or electronic template) for the care rendered for that diagnosis, and you specify a diagnosis pointer (24. E.) for each one of those procedure codes, the diagnosis pointer for each of those codes will be pointed to the injury, not the mechanism of injury. You cannot treat a mechanicsm of injury. For that reason, the injury is listed as the primary diagnosis.
 
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