give 2 examples for when an ”external cause” icd code is required

by Rodrick Cremin 10 min read

To code for these circumstances, you would submit the following external cause codes: Y93.A1 (Activity, treadmill); Y92.39 (Gymnasium as the place of occurrence of the external cause); and Y99.8 (Other external cause status, Recreation or sport not for income or while a student). 4.

Full Answer

What are external cause codes in ICD 10?

May 02, 2018 · ICD-10 External Cause Codes (V00-Y99) External Causes of Injury for Transport Accidents V00-V09 Pedestrian injured in transport accident V10-V19 Pedal cycle rider injured in transport accident V20-V29 Motorcycle rider injured in transport accident V30-V39 Occupant of three-wheeled motor vehicle injured in transport accident

When should I use an external cause and intent code?

Examples of place and activity codes a doctor might report in our example case are: Y92.414 Local residential or business street as the place of occurrence of the external cause. Y93.C2 Activity, hand held interactive electronic device.

Is there a mandatory reporting requirement for external cause codes?

Jan 08, 2016 · by ChiroCode. January 8th, 2016. Chapter 20 External Causes of Morbidity includes codes from V00 to Y99. They were greatly expanded in ICD-10-CM. They are intended to provide data for injury research and evaluation of injury prevention strategies. These codes capture how the injury or health condition happened (cause), the intent (unintentional ...

When to use multiple external cause codes for an accident?

CMS has released its view on the use of external cause diagnosis codes in ICD-10-CM. Recall that these are the secondary dx codes available for use in cases where a patient is presenting with an injury to identify just how the injury occurred (fall vs. motor vehicle accident vs. assault etc.) Just as with ICD-9-CM, there is no national ...

Why do we use external cause codes?

An external cause code is used secondary to a code from another chapter to provide further information about the nature of the injury or condition. Multiple external cause codes should be assigned to completely describe and explain the injury or health condition.

When should the cause be reported?

The cause should be reported before reporting the place, activity, or status. Place, activity, and status codes are assigned following all causal (intent) external cause codes

What is the code for adult abuse?

Adult and child abuse, neglect and maltreatment are classified as assault. Assault codes can indicate the external cause of injury for confirmed abuse, and a perpetrator code from category Y07 indicates the relationship between the victim and the perpetrator.

What is the ICD-10 code for fall due to ice and snow?

Codes in these chapters are used as complimentary codes which capture information about the situations surrounding an injury or illness, such as Fall Due to Ice and Snow, Chapter 20 (W00). Earlier ICD-10-CM chapters are for codes primary that represent an actual diagnosis like Stress facture (M84.3) or Listerial sepsis (A32.7).

What is the diagnosis code for a pizza delivery car?

The appropriate diagnosis codes here would be V43.53XA - car driver injured in collision with pick-up truck in traffic accident, initial encounter; Y92.411 - interstate highway as the place of occurrence of the external cause; Y93.C2 - activity, hand-held interactive electronic device; and Y99.0 - civilian activity done for income or pay.

What is a combination code?

Combination codes identify sequential events resulting in injury, such as fall resulting in striking against an object, with injury due to either event or both

What is status code?

Status codes indicate whether the injury or condition occurred during military activity, whether a non-military person was at work, and whether a student or volunteer was involved in the causal event. Coding Guidelines: An external cause code can never be a first-listed principal diagnosis.

What is Chapter 20 external cause of morbidity?

Chapter 20 External Causes of Morbidity includes codes from V00 to Y99. They were greatly expanded in ICD-10-CM. They are intended to provide data for injury research and evaluation of injury prevention strategies. These codes 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). Therefore they don’t actually describe a condition, rather they just provide additional data.

Why do chiropractors add codes to personal injury cases?

Chiropractors may elect to add these codes to personal injury cases because they may allow third parties to obtain information from the claim form, without needing to review the medical records. Auto injury claims might use the codes that begin with the letter “V”, which are all transport accidents.

What does the next character in a car accident claim mean?

The next character identifies the object that was struck. The following code might be used on the claim for a passenger of a car who was injured when the car struck a pick-up truck in traffic.

Is there a requirement to report external cause codes?

There is no national requirement for mandatory external cause code reporting, but voluntary reporting is encouraged. It may be helpful to review the chapter specific guidelines for external cause codes found in section 1.C.20.

What is the first-listed external cause code?

When the cause of an injury is identified by the Federal Government (FBI) as terrorism, the first-listed external cause code should be a code from category Y38, Terrorism.

Why should external cause codes be sequenced?

External cause codes are intended to provide data for injury research and evaluation of injury prevention strategies . These codes capture how the injury or health condition happened (cause), the intent (unintentional or accidental;

What is Y93 activity code?

Assign a code from category Y93, Activity code, to describe the activity of the patient at the time the injury or other health condition occurred.# N#An activity code is used only once, at the initial encounter for treatment. Only one code from Y93 should be recorded on a medical record.#N#The activity codes are not applicable to poisonings, adverse effects, misadventures or sequela.#N#Do not assign Y93.9, Unspecified activity, if the activity is not stated.#N#A code from category Y93 is appropriate for use with external cause and intent codes if identifying the activity provides additional information about the event.

What is Y92 code?

Codes from category Y92, Place of occurrence of the external cause, are secondary codes for use after other external cause codes to identify the location of the patient at the time of injury or other condition. Generally, a place of occurrence code is assigned only once, at the initial encounter for treatment.

When the cause of an injury is suspected to be the result of terrorism, a code from category Y38

When the cause of an injury is suspected to be the result of terrorism a code from category Y38 should not be assigned. Suspected cases should be classified as assault.

What is accidental intent?

If the intent (accident, self-harm, assault) of the cause of an injury or other condition is unknown or unspecified, code the intent as accidental intent. All transport accident categories assume accidental intent.

When to use late effect external cause code?

Use a late effect external cause code for subsequent visits when a late effect of the initial injury is being treated. Do not use a late effect external cause code for subsequent visits for follow-up care (e.g., to assess healing, to receive rehabilitative therapy) of the injury when no late effect of the injury has been documented.

When to report unspecified codes?

In fact, unspecified codes should be reported when they are the codes that most accurately reflects what is known about the patient’s condition at the time of that particular encounter. It would be inappropriate to select a specific code that is not supported by the medical record documentation or conduct medically unnecessary diagnostic testing in order to determine a more specific code.

When will the AMA release the new codes for 2021?

On October 6, 2021, the AMA released three new codes to track COVID-19 vaccinations in the pediatric population.

Is ICD-10-CM mandatory?

Just as with ICD-9-CM, there is no national requirement for mandatory ICD-10-CM external cause code reporting. Unless a provider is subject to a state-based external cause code reporting mandate or these codes are required by a particular payer, reporting of ICD-10-CM codes in Chapter 20, External Causes of Morbidity, is not required. If a provider has not been reporting ICD-9-CM external cause codes, the provider will not be required to report ICD-10-CM codes in Chapter 20, unless a new state or payer-based requirement regarding the reporting of these codes is instituted. Such a requirement would be independent of ICD-10-CM implementation. In the absence of a mandatory reporting requirement, providers are encouraged to voluntarily report external cause codes, as they provide valuable data for injury research and evaluation of injury prevention strategies.

Is it necessary to use unspecified codes in ICD-10?

In both ICD-9-CM and ICD-10-CM, sign/symptom and “unspecified” codes have acceptable, even necessary, uses. While specific diagnosis codes should be reported when they are supported by the available medical record documentation and clinical knowledge of the patient’s health condition, there are instances when signs/symptoms or unspecified codes are the best choices for accurately reflecting the healthcare encounter. Each healthcare encounter should be coded to the level of certainty known for that encounter.

Is external cause code required?

You can and probably should, but the use of External Cause codes is not required according to CMS and ICD-10 Guidelines. That was the question. Is it required? Bottom line. NO.

Is there a requirement to report external cause code?

You'll find this guidance in the ICD-10-CM Official Guidelines for Coding and Reporting at the beginning of your code book in the section on Chapter 20:#N#There is no national requirement for mandatory ICD-10-CM external cause code reporting. Unless a provider is subject to a state-based external cause code reporting mandate or these codes are required by a particular payer, reporting of ICD-10-CM codes in Chapter 20, External Causes of Morbidity, is not required. In the absence of a mandatory reporting requirement, providers are encouraged to voluntarily report external cause codes, as they provide valuable data for injury research and evaluation of injury prevention strategies.

What is the external cause code for length of treatment?

Use the full range of external cause codes: cause, intent, place of occurrence, activity and status for all injuries and other health conditions related to an external cause. Chapter 20 a4.

What is a late effect external cause code?

Late Effects of External Cause: 1) Late effects are reported using the external cause code with 7th character "S" for sequela. 2) A late effect external cause code should never be used with a current injury code. 3) Use a late effect external cause code for subsequent visits when a late effect of the initial injury is being treated. Do not use a late effect external cause code for follow-up care when no late effect is documented.

What is Y92 code?

Place of occurrence guideline: Codes from category Y92, place of occurrence of the external cause , are secondary cause codes for use after other oexternal cause codes to identify the location of the patient at the time of injury or other condition. A place of occurrence code is used only once, at the initial encounter for treatment. Only one code from Y92 (place) should be recorded. A place of occurr ence code should be used with an acitivity code, Y93. Do not use Y92.9 (unspecified place) is the place is not stated or is not applicable.

How many place codes are there in a clinical report?

Only 1 place code, 1 activity code, and 1 status code per encounter. If the reporting format limits the number of external cause codes than can be used in reporting clinical data, report the code for the cause/intent most related to the principal diagnosis.

How many place codes are there in a status code?

Only 1 place code, 1 activity code, and 1 status code per encounter.

What is primary injury?

Primary injury with damage to nerves/blood vessels: When a primary injury results in minor damage to peripheral nerves or blood vessels, the primary injury is sequenced first with additional codes for injuries to nerves and spinal cord and/ or injury to blood vessels.

What is the undetermined intent guideline?

Unknown or Undetermined Intent Guideline: If the intent of the cause of an injury or other conition is unknown or unspecified, code the intent as accidental intent. All transport accident categories assume accidental intent. External cause codes for events of undetermined intent are only for use if the documentation in the record specifies that the intent cannot be determined. (i.e. Did he fall, or was he pushed?)

What is the first cause code?

In other words, the first cause code you list should be the one that describes the cause or intent most closely related to the principal diagnosis. Furthermore, per the official coding guidelines, external cause codes for the following events take precedence over all other external cause codes, in the following order of importance (i.e., the third-listed item trumps all items except the first and second-listed items):

Is ICd 10 more specific than ICd 9?

With five times as many codes as ICD-9, ICD-10 is certainly more specific. It’s no wonder, then,...

Can you report an injury more than once?

Typically, you would only report place of occurrence, activity, and external cause status codes during your initial evaluation of the patient. However, there are a handful of codes—particularly ones that describe how an injury happened—that you can report more than once.

Do you have to report external cause codes?

However, even though there’s no national requirement for cing providers to report external cause codes, the coding guidelines strongly encourage medical professionals to do so anyway because the codes “provide valuable data for injury research and evaluation of injury prevention strategies.”.

Can you submit external cause codes for every diagnosis?

They don’t apply to all categories of diagnosis codes. That is, you shouldn’t submit external cause codes for every single diagnosis, because in some cases, it doesn’t make sense to attribute a condition to a specific cause.

Chapter 20, External Causes of Morbidity

  • Consisting of more than 7500 codes and 9% of the total volume of codes, this is the third largest chapter in ICD-10-CM. Codes in Chapter 20 report the cause of injury or health condition, the intent (unintentional/accidental or intentional such as suicide or assault), the place of injury, the activity of the patient at the time of injury, and the patient's status (military or civilian). These codes are …
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External Cause Place, Activity, and Status Codes

  • External cause place, activity, and status codes provide more information about the injury or condition. A single code from category Y92, external cause place, is used to identify the place of occurrence of the external cause when applicable and known. The place of occurrence code is sequenced following the main external cause code(s). This code is assigned in conjunction wit…
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Adult and Child Abuse

  • Adult and child abuse, neglect and maltreatment are classified as assault. Assault codes can indicate the external cause of injury for confirmed abuse, and a perpetrator code from category Y07 indicates the relationship between the victim and the perpetrator. Coding Example: A college student is the victim of a random beating in a park. The care pr...
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Transport Accidents

  • All transport accidents are assumed as accidental intent. If the intent is unknown in terms of unintentional (accidental) or intentional (self-harm or assault), then the intent should be coded as accidental by default. Undetermined intent is only used in external cause codes if the intent cannot be determined. A transport accident involves a moving or running vehicle. Land transpor…
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External Cause Sequelae

  • Late effects or sequela of a previous injury are reported using the seventh character S. These external cause codes for sequela should not be used with related codes specifying the nature of the current injury. External cause codes for sequela should also not be used when no late effect is documented and the subsequent visit is for routine followup care to assess healing or receive re…
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A. General External Cause Coding Guidelines

  • 1) Used with any code in the range of A00.0-T88.9, Z00-Z99
    An external cause code may be used with any code in the range of A00.0-T88.9, Z00-Z99, classification that is a health condition due to an external cause. Though they are most applicable to injuries, they are also valid for use with such things as infections or diseases due to an extern…
  • 2) External cause code used for length of treatment
    Assign the external cause code, with the appropriate 7th character (initial encounter, subsequent encounter or sequela) for each encounter for which the injury or condition is being treated. Most categories in chapter 20 have a 7th character requirement for each applicable code. Most categ…
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B. Place of Occurrence Guideline

  • Codes from category Y92, Place of occurrence of the external cause, are secondary codes for use after other external cause codes to identify the location of the patient at the time of injury or other condition. Generally, a place of occurrence code is assigned only once, at the initial encounter for treatment. However, in the rare instance that a new injury occurs during hospitalization, an additi…
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C. Activity Code

  • Assign a code from category Y93, Activity code, to describe the activity of the patient at the time the injury or other health condition occurred. An activity code is used only once, at the initial encounter for treatment. Only one code from Y93 should be recorded on a medical record. The activity codes are not applicable to poisonings, adverse effects, misadventures or sequela. Do n…
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E. If The Reporting Format Limits The Number of External Cause Codes

  • If the reporting format limits the number of external cause codes that can be used in reporting clinical data, report the code for the cause/intent most related to the principal diagnosis. If the format permits capture of additional external cause codes, the cause/intent, including medical misadventures, of the additional events should be reported rather than the codes for place, activ…
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F. Multiple External Cause Coding Guidelines

  • More than one external cause code is required to fully describe the external cause of an illness or injury. The assignment of external cause codes should be sequenced in the following priority: If two or more events cause separate injuries, an external cause code should be assigned for each cause. The first-listed external cause code will be selected in the following order: External code…
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G. Child and Adult Abuse Guideline

  • Adult and child abuse, neglect and maltreatment are classified as assault. Any of the assault codes may be used to indicate the external cause of any injury resulting from the confirmed abuse. For confirmed cases of abuse, neglect and maltreatment, when the perpetrator is known, a code from Y07, Perpetrator of maltreatment and neglect, should accompany any other assault c…
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H. Unknown Or Undetermined Intent Guideline

  • If the intent (accident, self-harm, assault) of the cause of an injury or other condition is unknown or unspecified, code the intent as accidental intent. All transport accident categories assume accidental intent.
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I. Sequelae (Late Effects) of External Cause Guidelines

  • 1) Sequelae external cause codes
    Sequela are reported using the external cause code with the 7th character "S" for sequela. These codes should be used with any report of a late effect or sequela resulting from a previous injury. See Section I.B.10 Sequela (Late Effects)
  • 2) Sequela external cause code with a related current injury
    A sequela external cause code should never be used with a related current nature of injury code.
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J. Terrorism Guidelines

  • 1) Cause of injury identified by the Federal Government (FBI) as terrorism
    When the cause of an injury is identified by the Federal Government (FBI) as terrorism, the first-listed external cause code should be a code from category Y38, Terrorism. The definition of terrorism employed by the FBI is found at the inclusion note at the beginning of category Y38. U…
  • 2) Cause of an injury is suspected to be the result of terrorism
    When the cause of an injury is suspected to be the result of terrorism a code from category Y38should not be assigned. Suspected cases should be classified as assault.
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K. External Cause Status

  • A code from category Y99, External cause status, should be assigned whenever any other external cause code is assigned for an encounter, including an Activity code, except for the events noted below. Assign a code from category Y99, External cause status, to indicate the work status of the person at the time the event occurred. The status code indicates whether the event occurred dur…
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