Avoid E Codes as First Dx, or Face Claims Rejection

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  • September 26, 2012
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When submitting claims to Medicare, be certain that you aren’t listing an ICD-9-CM E code as the first diagnosis, or your claims will be returned to you. E codes describe external causes of injury or poisoning. ICD-9-CM prohibits E codes from being reported as principal diagnoses.
The Centers for Medicare & Medicaid Services (CMS) instructs contractors in Transmittal 2515 to return claims submitted on Form CMS-1500 when an ICD-9-CM E code is reported as the first diagnosis of the claim in Item 21, effective Jan. 1, 2013. This instruction will bring the policy for handling Form CMS-1500 paper claims into alignment with the policy for handling claims initially submitted in electronic format. The new edit will also apply to ICD-10-CM codes V00-Y99 when they become effective on Oct. 1, 2014.
Refer to MLN Matters® MM7700 for handling CMS claims reported with an E code as the first diagnosis code in Item 21.

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No Responses to “Avoid E Codes as First Dx, or Face Claims Rejection”

  1. Brandi Tadlock says:

    I’ve like to think of E-codes as “FYI” codes. They’re used in conjunction with injury and poisoning diagnosis codes, to explain how that injury or poisoning happened.
    I can understand why someone might report an E-code first – for example, when the reason for the encounter is documented as a “Dog bite” – but “dog bite” isn’t the actual injury – it’s just HOW the injury occurred. A puncture wound (or laceration, etc.) is the real reason for the encounter.
    It can be confusing to new coders, but ICD-9 guidelines are pretty clear about E-code usage (in that, they’re never supposed to be used as a primary diagnosis) – the ‘How it happened’ code, never comes before the ‘what’s wrong’ code. Just my two cents!
    Brandi Tadlock, CPC, CPC-P, CPMA, CPCO