External Cause Codes for Injuries

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Joined: Sat Dec 20, 2014 9:32 pm

Thu Aug 15, 2019 3:31 pm

Hello! Thank you in advance for any guidance you can offer.

On a recent internal audit, it was observed that some coding staff in the trauma specialty are not using external codes while coding procedures for the initial treatment. For example abdominal wound repairs due to assault by a gun, or heart wounds repaired due to being assaulted by a knife. Coding staff in the family med specialty do use the external codes on procedures as well as any allowed E/M for the initial visit/treatment.

One of the coders did some research and found the following from AAPC and CMS:

Taken from AAPC:
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 .

https://www.aapc.com/blog/27301-icd-10- ... hole-story

Taken from CMS:

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.
An external cause status code is used only once, at the initial encounter for treatment. Only one code from Y99 should be recorded on a medical record.
https://www.cms.gov/Medicare/Coding/ICD ... elines.pdf

CPT guidance states that a code from categories V00-Y99 should be used to provide additional information as to the cause of the condition.

We would appreciate guidance from NAMAS on this to help develop a "best practice" going forward.

Warm Regards,
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