ICD-10-CM: Are You Ready for External Cause Coding?

When was the last time you had to code a record where the patient was either pecked by a rooster or injured while tap dancing at a fundraising event?

More than likely, we will all have to brush up on our external cause coding as a result of ICD-10-CM. Since ICD-10-CM is an alphanumeric system, we believe that carriers will want this data submitted when appropriate on injury claims. In ICD-10-CM a separate chapter is dedicated to external cause coding. You will find these codes in Chapter 20, External Causes of Morbidity, with a code range of V00-Y99.

Let's review the ICD-10-CM rules for proper external cause coding.

1. Never used as a primary diagnosis
2. Consider how the accident happened
3. Consider where the accident occurred
4. Consider what activity was the patient engaged in when the accident happened
5. External cause code status: indicate whether the accident or injury happened during a paid or volunteer activity (Y99.0-Y99.99)

Here is an example of an accident case coded with ICD-10-CM.

A 30-year-old patient was at a sports gymnasium, participating in a tap dancing contest to raise funds for muscular dystrophy. She slipped on the gym floor and fell, injuring her left ankle. The ankle was X-rayed and no fracture was evident. Her ankle was wrapped in an ACE™ bandage and she was given proper RICE instructions. She will followup with her primary care physician in 3 days. Final diagnosis was a left ankle sprain.

Sprain, left ankle: S93.402A
Slip, fall (same level): W01.0XXA
Place: Sports, gym Y92.39
Activity: Dancing Y93.41
Status: Volunteer Activity Y99.2

Learning something new is always challenging and coding external causes will be no exception. However, with a little practice and careful review of the guidelines you'll soon develop the confidence to accurate code any injury case in ICD-10-CM.

2013 ICD-10-PCS Codes
The newest release of ICD-10-PCS updates has been released. In the 2013 version only 2 new codes were added, however, there are 262 revised titles. Here is a breakdown of the number of codes in each category.

ICD-10-PCS Code 2013 Totals, By Section

More information for the codes can be found here.

Female patient, aged 22, suffered in past with migraines: hemiplegic migraine, menstrual migraine, and tension-type headache. She has 1-2 attacks per month and suffers with vomiting, dizziness, and vertigo. She is currently taking beta-blockers and anti-depressants. She has tried relaxation, massage, feverfew, and reflexology. She started suffering at the age of 14 which got worse when 16-17 and would vomit 6-9 times during a migraine attack. Presents today with complaints of severe, throbbing pain on the right side of her head along with weakness on the same side. She has had nausea and vomiting and experiencing an aura for the past hour. Patient given Maxalt upon arrival and now appears to be doing better.

ICD-10-CM G43.409 Hemiplegic migraine, not intractable, without status migrainosus

Rationale: The documentation indicates the patient has been having symptoms for one hour so the code is selected to indicate the migraine is not intractable and without status migrainosus.

In this section, we share strategies to help your practice successfully implement ICD-10-CM. Please remember to track your progress in your ICD-10 Implementation Tracker on AAPC's website.

Working With Your Vendors
As we found out with the implementation of 5010, testing is an important piece of any system change. Work with your vendors early to determine their testing capabilities for ICD-10-CM and get on their schedules early on. Don't accept "No" from a vendor, even if they have tested with others. Make sure that your system will work for your practice and individual needs.

ICD-10 Forums
Need some help from others going through the ICD-10 implementation process or have other questions regarding this massive transition? Now there is a new forum dedicated for your ICD-10 conversations.