ED Coding and Reimbursement Alert

Question: A patient fell five weeks ago, and now presents in the ED complaining of chest pain. The physician doesn't know whether the pain is associated with the fall, and the patient never received treatment for the fall. Should we report the appropriate E code on the current admission documentation? Is there a relevant time frame for this?


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Answer: You shouldn't report a current E code unless the doctor specifically indicated that the chest pain resulted from the prior fall. Because the physician doesn't know, your best bet is to report the chest pain diagnosis (along with the patient's other signs and symptoms).

You can describe external causes of injury with two types of E codes--current E codes, which describe how the injury happened (such as -fell from a ladder-), and late effect E codes, which explain that the presenting problem is due to a previous injury.

Describing injuries with current E codes means either  that the injury just happened or that the patient is still under treatment for it. Late effect codes have no designated time frame, so you can report them anytime the physician indicates that the presentation is due to an earlier incident.

One other option to consider is V15.5 (Personal history of an injury), if it seems appropriate in the context of the treatment.