Neurosurgery Coding Alert

Insurers often won't pay your WC claim without information about the accident or disease's cause Suppose a patient suffers a vertebral fracture with nerve damage after falling off of scaffolding at his construction job. Your neurosurgeon sees the patient, and you report 806.24 for the fracture, but the patient's workers' comp insurer denies the charge. Why? 
 
Payers require E codes: When providing diagnoses for workers' compensation claims, you must add the appropriate E code to describe how the work-related diagnosis occurred.
 
E codes describe external causes of injuries or accidents, and 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 case above, you should report 806.24 (Fracture of vertebral column with spinal cord injury; dorsal [thoracic], closed; T1-T6 level with other specified spinal cord 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 suffered the injury and a second 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 of 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 great 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. And, contrary to popular belief, workers' compensation insurance often covers occupational illnesses, says Mary J. Brown, CPC, CMA, coding specialist at OrthoWest PC, a seven-physician practice in Omaha, Neb.
 
Section 2370.1 of the Medicare Carriers Manual (MCM) states that Medicare policy requires compensation for [...]