External causes of morbidity ICD-10-CM Code range V00-Y99V00-X58. Accidents.X71-X83. Intentional self-harm.X92-Y09. Assault.Y21-Y33. Event of undetermined intent.Y35-Y38. Legal intervention, operations of war, military operations, and terrorism.Y62-Y84. Complications of medical and surgical care.Y90-Y99.
If you need to use the S 7th character, use both the injury/condition code that precipitated the sequela and the code for the sequela itself. Add the S only to the injury code, not the sequela code. The S identifies the injury or condition responsible for the sequela.
ICD-10 External Cause Codes (V00-Y99) are secondary codes that capture specific details about an injury or health event.
The seventh character under ICD-10 defines the “type of encounter”.
Which of the following conditions would be reported with code Q65. 81? Imaging of the renal area reveals congenital left renal agenesis and right renal hypoplasia.
A8 All seven characters must be specified to be a valid code. If the documentation is incomplete for coding purposes, the physician should be queried for the necessary information. A9 Within a PCS table, valid codes include all combinations of choices in characters 4 through 7 contained in the same row of the table.
NOTE: Recall that external cause, place, activity, and status codes are not applicable to poisonings, adverse effects, misadventures, or late effects.... Child and adult abuse. Terrorism events (events designated by the FBI as terrorism) Cataclysmic events. Transport accidents.
The seventh characters available for these open fractures are: B, Initial encounter for open fracture type I or II. C, Initial encounter for open fracture type IIIA, IIIB, or IIIC. E, Subsequent encounter for open fracture type I or II with routine healing.
Generally, the following three options are available as 7th character extensions: A, initial encounter. D, subsequent encounter. S, sequela (complications or conditions resulting from an injury)
Assuming the provider is providing active care, a seventh character of “A” is appropriate, regardless of how many times the provider saw the patient previously.
In medicine, an external cause is a reason for the existence of a medical condition which can be associated with a specific object or acute process that was caused by something outside the body.
External Cause Codes Just as with ICD-9-CM, there is no national requirement for mandatory ICD-10-CM external cause code reporting.
Certain ICD-10-CM categories have applicable seventh characters. Chapter 19 – “Injury, poisoning, and certain other consequences of external cause” require a 7 th character, or as notes in the tabular list instruct. The seventh character also must always be the seventh character in the data field. If a code that requires a seventh character does not include the full seven characters, a placeholder X must be used to fill in the empty character fields.
These codes, one from each subcategory, are needed to complete the scale. The seventh character indicates when the scale was recorded. The seventh characters should match for all three codes.
The seventh character A, initial encounter, is used while the patient is receiving active treatment for a condition.
Fractures of specified sites are coded individually, by site, in accordance with both the provisions within categories S02, S12, S22, S32, S42, S49, S52, S59, S62, S72, S79, S82, S89 and S92, and the level of detail furnished by medical record content.
These codes permit the classification of environmental events, circumstances, and conditions as the cause of injury and other adverse effects, and are to be used in addition to codes that report the actual injury.
E813.1 Motor vehicle traffic accident involving collision with other vehicle injuring passenger in motor vehicle other than motorcycle. Some providers already use these codes voluntarily or when required on auto insurance claims; however, many billers are unfamiliar with external cause codes.
The Y codes contain two important categories: Y92 for place of occurrence of the external cause and Y93, which is an activity code. The guidelines state these codes are to be used with one another, and are only reported on the initial encounter.
The Centers for Medicare & Medicaid Services (CMS) encourages you to do so, however, because they provide valuable data for injury research and evaluation of injury prevention strategies. They may also be helpful for determining liability in third-party injury claims.
ICD-9-CM has been the standard since 1979, but has outlived its usefulness. Because of its structure, ICD-10-CM provides better data for research and statistical analysis than ICD-9-CM. Although there is no national mandate to report them, external cause codes provide a unique opportunity to report significant detail not available in ICD-9-CM.
External cause code reporting is voluntary (but is encouraged) when ICD-10-CM is implemented. It provides the opportunity to report enhanced detail, and could streamline the process of claims submission and payment adjudication. It may also improve the process of data collection for researchers and policy makers. Physicians and coders, however, must take the time to get familiar with coding guidelines and conventions to take advantage of this opportunity provided by ICD-10 .#N#Sources:#N#Medicare Learning Network, ICN 902143, April 2013#N#Complete and Easy ICD-10-CM Coding for Chiropractic, 2nd edition, The ChiroCode Institute, 2013.#N#“ICD-10-CM. It’s closer than it seems,” CMS News Updates. May 17, 2013.#N#Evan M. Gwilliam, DC, MBA, CPC, CCPC, CPC-I, CCCPC, CPMA, NCICS, MCS-P, is the director of education for FindACode, and is the only chiropractic physician who is also an AAPC certified ICD-10-CM trainer. He spends most of his time teaching chiropractic physicians and other health professionals how to get ready for ICD-10-CM. If you are looking for a speaker or ICD-10-CM resources, he can be reached at [email protected]. Gwilliam is a member of the Provo, Utah, local chapter.
Background: Most ICD-10-CM external cause-related codes (V, W, X, Y, and T) have a 7th character that indicates whether the code is associated with the initial encounter (A), subsequent encounter (D), or a sequela (S). The initial encounter character (A) is used while the patient is receiving active treatment (e.g., emergency department encounter, surgery, evaluation and treatment by a new physician) for the condition. The subsequent encounter character (D) is used for encounters after the patient has received active treatment for the condition and is receiving routine care for the injury during the healing or recovery phase. The sequela character (S) is used with any report of a late effect or sequela resulting from a previous injury.
Background: In ICD-10, W16 Diving or Jumping into Water Causing Injury other than Drowning or Submersion consists of a single code and is placed in Unintentional Fall in the ICD-10 External Cause Matrix. In ICD-10-CM, W16 includes multiple codes for falling, jumping or diving into a swimming pool or natural body of water, with separate codes that specify drowning/submersion or other injuries. Similarly, in ICD-10, W22 Striking against or Struck by Other Objects consists of a single code and is placed in Unintentional Struck by/against in the ICD-10 External Cause Matrix. In ICD-10-CM, W22 includes multiple codes for striking against or struck by other objects, including two codes specific to striking against the wall of swimming pool causing drowning and submersion (W22.041) and other injury (W22.042).
External cause of injury frameworks based on the International Classification of Diseases (ICD) have served the injury field in providing standards for presenting and analyzing state, national and international injury mortality and morbidity data. The external cause of injury framework, commonly called the external cause matrix, categorizes ICD codes into major mechanism (e.g., motor vehicle-trac, cut/pierce, drowning, fall, firearm, fire/burn, natural/environmental, poisoning) by intent of injury (i.e., unintentional, self-harm, assault, legal intervention/war, undetermined) categories.
ICD-10-CM says the seventh character S is “for use for complications or conditions that arise as a direct result of an injury, such as scar formation after a burn. The scars are sequelae of the burn.” In other words, sequela are the late effects of an injury.#N#Perhaps the most common sequela is pain. Many patients receive treatment long after an injury has healed as a result of pain. Some patients might never have been treated for the injury at all. As time passes, the pain becomes intolerable and the patient seeks a pain remedy.#N#A late effect can occur only after the acute phase of the injury or illness has passed; therefore, you cannot report a code for the acute illness and a code for the late effect at the same encounter, for the same patient. The only exception occurs if both conditions exist (for example, the patient has a current cerebrovascular condition and deficits from an old cerebrovascular condition).#N#When reporting sequela (e), you usually will need to report two codes. The first describes the condition or nature of the sequela (e) and second the second describes the sequela (e) or “late effect.” For example, you may report M81.8 Other osteoporosis without current pathological fracture with E64.8 Sequelae of other nutritional deficiencies (calcium deficiency).#N#If a late effect code describes all of the relevant details, you should report that one code, only (e.g., I69.191 Dysphagia following nontraumatic intracerebral hemorrhage ).#N#For example: A patient suffers a low back injury that heals on its own. The patient isn’t seeking intervention for the initial injury, but for the pain that persists long after. The chronic pain is sequela of the injury. Such a visit may be reported as G89.21 Chronic pain due to trauma and S39.002S Unspecified injury of muscle, fascia and tendon of lower back, sequela.
ICD-10-CM defines subsequent encounters as “encounters after the patient has received active treatment of the injury and is receiving routine care for the injury during the healing or recovery phase. Examples of subsequent care are: cast change or removal, removal of external or internal fixation device, medication adjustment, other aftercare and follow up visits following injury treatment.”#N#A seventh character “D” is appropriate during the recovery phase, no matter how many times he has seen the provider for this problem, previously.#N#Note that ICD-10-CM guidelines do not definitively establish when “active treatment” becomes “routine care.” Active treatment occurs when the provider sees the patient and develops a plan of care. When the patient is following the plan, that is subsequent. If the provider needs to adjust the plan of care—for example, if the patient has a setback or must returns to the OR—the care becomes active, again.
In other words, sequela are the late effects of an injury. Perhaps the most common sequela is pain. Many patients receive treatment long after an injury has healed as a result of pain. Some patients might never have been treated for the injury at all.
A late effect can occur only after the acute phase of the injury or illness has passed; therefore, you cannot report a code for the acute illness and a code for the late effect at the same encounter, for the same patient.