ED Coding and Reimbursement Alert

Question: Can you share an example of when I might use the "External cause" codes in ICD-10? Insurers keep rejecting claims that contain the codes.

Codify Subscriber

Answer: Correct coding requires you to report these codes, which describe the causes of injuries, diseases and other issues. These codes are part of the ICD-10 system, which instructs you to code an encounter to the highest specificity possible.

Coding example: A five-year-old girl falls from the jungle gym on the school playground and suffers a2.0-cm cut on her right eyelid. The emergency department physician performs a simple repair.

You should report 12011 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less) linked to a primary diagnosis of S01.111 (Laceration without foreign body of right eyelid and periocular area) and a supplementary diagnosis of W09.2XXA (Fall on or from jungle gym, initial encounter) in this situation.

Although payers may not reimburse you more for these, you should include them on your claim. However, since you say you're seeing claims rejections when you include these codes, it's possible that you're trying to report them as primary diagnoses. Unfortunately, these codes cannot be billed as primary. They'll always be reported after your primary diagnosis.