Neurology & Pain Management Coding Alert

WC insurers often require information about the accident or disease's cause Workers' compensation (WC) claims don't just apply to accidents - you may see patients who present with work-related diseases as well as injuries. Applying E codes strengthens your WC claims for both accidents and occupational illnesses by giving the payer the whole story, experts say.
 
Payers require E codes: Suppose a patient suffers spinal cord injury after falling off of scaffolding at his construction job.
 
Your neurologist sees the patient, and you report 952.x for the nerve damage, but the patient's workers' comp insurer denies the charge. Why? Because you forgot to add the appropriate E code to describe how the work-related diagnosis occurred.
 
You should use E codes to describe external causes of injuries or accidents. E codes range from the common (E880.9, Fall on or from other stairs or step) to the obscure (E847, Accidents involving cable cars not running on rails) and describe scores of accidents and injuries. In short, says Terry Fletcher, BS, CPC, CCS-P, CCS, CMSCS, CMC, a coding and reimbursement specialist in Laguna Niguel, Calif., E codes often help answer the question, "How did it happen?"
 
In the example above, the coder should report 952.x, (Spinal cord injury without evidence of spinal bone injury) followed by E881.1 (Fall from scaffolding) and E849.3 (Place of occurrence; industrial place and premises).
 
Two E Codes Double Your Specificity Some workers' compensation insurers require you to report two E codes together - one code to describe how the patient was injured, and a second (as in the above example) to describe where the accident occurred.
 
You'll find the "place of occurrence" codes in the E849.x series. For instance, if a patient falls off a ladder while working on a farm, you should report E881.0 (Fall from ladder) and E849.1 (Place of occurrence; farm).
 
Remember: "E codes do not change your reimbursement amount, because they are considered 'for informational purposes only' codes," says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for the CRN Institute, an online coding certification training center.
 
You should never report E codes in lieu of a diagnostic code to describe an injury, but E codes help the carrier understand how the patient was injured. Because workers' compensation insurers' payment decisions hinge on whether the patient hurt himself at work, your E codes can help you collect.
 
"The importance of the E codes is that they confirm that, yes, the patient was hurt at work," Jandroep says. Workers' Comp Covers Diseases, Too Although most coders immediately think of accident-related injuries when they discuss workers' compensation claims, remember that occupational circumstances cause some diseases and illnesses as well.
 
Contrary to popular belief, workers' compensation insurance often covers occupational [...]