Tune in to this monthly online coding column from Melanie Endicott to learn about challenging areas and documentation opportunities for ICD-10-CM/PCS.
ICD-9-CM includes a supplemental section, E codes, to describe the external causes of injuries and poisonings. These codes are secondary codes for use in any health care setting, which are used to provide data for injury research and evaluation of injury prevention strategies. E codes capture how an injury, poisoning, or adverse effect 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 place where the event occurred.
In ICD-10-CM, the E codes have moved to Chapter 20: External Causes of Morbidity (V01-Y99). The external cause codes are used essentially the same in ICD-10-CM as they are in ICD-9-CM, with a few modifications as shown below.
When to Use External Cause Codes
In ICD-9-CM, E codes are only assigned on the initial encounter, whereas in ICD-10-CM, the external cause codes are used for the length of the treatment. Seventh characters are provided to describe the encounter—initial, subsequent, or sequela. There are no seventh characters in ICD-9-CM.
No External Cause Code Needed in Certain Circumstances
No external cause code from ICD-10-CM Chapter 20 is needed if the external cause and intent are included in a code from another chapter, such as T42.3X1A, Poisoning by barbituates, accidental, intentional, initial encounter. This is a new guideline for ICD-10-CM.
ICD-9-CM to ICD-10-CM Code Comparisons
The structure of the external cause codes has changed from ICD-9-CM to ICD-10-CM. The table below includes a few examples that illustrate the changes.
|Documentation||ICD-9-CM Code||ICD-10-CM Code|
|Fall from ladder, initial encounter||E881.0, Fall from ladder||W11.XXXA, Fall on and from ladder, initial encounter|
|Motorcycle driver injured in collision with a van on the interstate, initial encounter||E812.2, Motor vehicle traffic accident (collision), motorcyclist||V23.4XXA, Motorcycle driver injured in collision with car, pick-up truck or van in traffic accident, initial encounter|
|Struck by baseball bat, subsequent encounter (follow-up visit for fracture care)||No E code assigned (only assigned on initial visit in ICD-9-CM)||W21.11XD, Struck by baseball bat, subsequent encounter|
An important note to keep in mind is that there is no national requirement for mandatory external cause reporting in ICD-9-CM or ICD-10-CM. However, there are some state-based external cause reporting mandates and providers are encouraged to voluntarily report external cause codes, as they provide valuable data for injury research and evaluation of injury prevention strategies.
Centers for Medicare and Medicaid Services. 2014 ICD-9-CM Official Guidelines for Coding and Reporting. http://www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm#guidelines.
Centers for Medicare and Medicaid Services. 2014 ICD-10-CM Official Guidelines for Coding and Reporting. http://www.cdc.gov/nchs/data/icd/icd10cm_guidelines_2014.pdf.