Wiki External Cause Coding

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rjenn86

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When pt comes in with an injury we use external cause codes to state what happened to the patient (if that ins company is requiring it), such as a medial meniscus tear, acl tear, fracture etc. If pt comes in with a condition such as tendinitis, epicondylitis, etc do we code external cause codes? We are receiving conflicting information and would like clarification? Thanks in advance!
 
The CMS 'Myths and Facts' publication from June 2015 gives this guidance on external cause codes that might help:

"Similar to ICD-9-CM, there is no national requirement for mandatory ICD-10-CM external cause code reporting. Unless you are subject to a State-based external cause code reporting mandate or these codes are required by a particular payer, you are not required to report ICD-10-CM codes found in Chapter 20 of the ICD-10-CM, External Causes of Morbidity. If you have not been reporting ICD-9-CM external cause codes, you will not be required to report ICD-10-CM codes found in Chapter 20 unless a new State or payer-based requirement about the reporting of these codes is instituted. If such a requirement is instituted, it would be independent of ICD-10-CM implementation. In the absence of a mandatory reporting requirement, you are encouraged to voluntarily report external cause codes, as they provide valuable data for injury research and evaluation of injury prevention strategies."
 
External cause coding

I typically only use external cause codes for injuries. If you have certain carriers who require them for chronic conditions related to a specific activity, then I would just use an activity code from Y93 series if the reason is documented. The external cause codes aren't limited to injuries. For example, you mentioned tendinitis as a chronic condition. if the doctor states the tendinitis is related to the patient playing tennis or golf, you can find this listed in the Y93 category. You can also use the place of occurrence in addition to the activity code, if desired.

Hope this helps!
Amy Meyers, CPC, ICD-10 certified
 
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