Review Three Coding Challenges for Reporting Injuries

Thu, Jun 2, 2016 --

ICD-10

icd 10 injury codes, icd-10 changes, icd-10 challenges, icd 10 implementation, icd-10 issues, icd-10 2016, icd-10 three coding challenges

Physicians of almost every specialty care for patients’ injuries — ranging from the mundane (S60.031A, Contusion of right middle finger without damage to nail, initial encounter) to the more serious (S48.122A, Partial traumatic amputation at level between left shoulder and elbow, subsequent encounter). Have you and your providers mastered the complexity of ICD-10-CM’s injury coding rules?

Three Coding Challenges for Reporting Injuries

Injury diagnosis coding offers three unique challenges:

  1. The seventh character extender

There are some complete ICD-10-CM codes that are only three digits (I10, Essential hypertension), but you won’t find many of those in the injury chapters. Coding for injuries with ICD-10 requires a seventh character to indicate the “episode of care.” That means you assign a seventh character to indicate whether your provider is seeing the patient for this injury for active treatment, for a followup from the initial injury, or because of long-term after effects or sequela from the original injury. Fracture reporting offers even more of the alphabet in the extender.

  1. The placeholder “X”

Speaking of that seventh character, what happens if the rest of the code is only 5 characters? When the guidelines said the episode of care letter goes at the seventh space, they weren’t kidding. Placeholder “X” comes in handy when you have to report a code like S82.61XA (Displaced fracture of lateral malleolus of right fibula, initial encounter for closed fracture).

  1. Three optional occurrence codes.

When you report injuries, you may need to use a secondary external cause code to describe how the injury occurred. This isn’t a big change from ICD-9, where some payers required E codes. However, ICD-10 also offers three additional optional occurrence codes for your reporting pleasure.

A Look at External Cause and Place of Occurrence Codes

At this point, I’d be surprised if most coders weren’t masters of the seventh digit and its pal, placeholder “X.” It’s true, though, that some were confused initially by the episode of care concept of A, D, and S, probably because they tried to make it correspond to the CPT® definition of new and established patients.

But those external cause and place of occurrence codes — these deserve a second look if only because they’ve been the butt of every ICD-10 joke since the new diagnosis coding system was announced. (Here’s one of my own accountings of weird yet wonderful external cause codes.) Can you even count how many times you heard the ICD-10 haters chortle about W22.02XS (Walked into lamppost, sequela)?

The thing is, external cause codes can offer important public safety information for researchers who are trying to figure out how to prevent accidents. So though some of these codes seem silly, they aren’t really a joke. Again, much like the ICD-9’s E codes, ICD-10’s external cause of morbidity (V00-Y99) codes are optional with most payers. If your payers required E codes back in the olden days, no doubt they still want V, W, and Y codes with ICD-10. Just don’t ever report an external cause code as the first listed, because these can never be principal diagnoses.

Finally, the additional three occurrence codes are also optional. These codes are used to tell where the patient was when the injury occurred, what she was doing (though in some cases this is redundant to the external cause code), and whether the injury occurred while at work, in the military, or as a civilian doing a volunteer activity.

Check Out This External Cause and Occurrence-Laden Scenario

We’ll close with a quick scenario. While strolling through a state park one day and simultaneously staring at her smartphone screen, Susan accidentally walked into a tree branch where a turtle was sunning itself. Startled, the turtle fell off the branch and scurried away, first scraping Susan’s left wrist with its claws. She suffered an abrasion. Here’s how you’d report that story. Remember, the only required diagnosis code (depending on your payer) is the first one.

  • S60.812A, Abrasion of left wrist, initial encounter
  • W59.22XA, Struck by turtle, initial encounter
  • Y92.830, Public park as the place of occurrence of the external cause
  • Y93.01, Activity, walking, marching and hiking
  • Y93.C2, Activity, hand held interactive electronic device

What About You?

Do you ever get to use the external cause codes with your payers? I’m curious! Let us know in the comment box below.

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About 

Susan taught health information and healthcare documentation at the community college level for more than 20 years. She has a special love for medical language and terminology. She is passionate about ensuring accurate patient healthcare documentation through education. She has a master's degree in healthcare administration, is a certified healthcare documentation specialist, and serves as immediate past president for the Association for Healthcare Documentation Integrity (AHDI).

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