Pediatric Coding Alert

Question: In the February 2004 Pediatric Coding Alert Extra, the "You Be the Expert" scenario describes a patient falling off monkey bars. Should I report E codes, in addition to the fracture and E/M codes that you recommend?

Nevada Subscriber Answer: Although E codes (E800-E999) don't generate revenue, you should report them in addition to the appropriate CPT and ICD-9 codes. E codes help public-health officials plan prevention programs, and indicate, with diagnosis codes, a classification system for injuries.

For instance, with the playground accident, using an E code to describe the accident could help officials gather statistics on playground safety. You would report E884.0 (Fall from playground equipment) to indicate that a fall from monkey bars caused the child's injuries. Use the E code in addition to the finger fracture treatment (26720, 816.00) and office visit code (99213-25, 923.8/V71.4) as the "You Be the Expert" answer recommends.

Many insurers want to see E codes for accidents and injuries. The information saves them the trouble of going through the patient for the same information that the codes can describe succinctly. For these payers, not using the E codes can delay claims for "additional information pending" or result in denials for lacking identifying information. But be careful. Some coders report that some insurers reject claims containing E codes. So, check with your payers for requirements, such as limiting informational codes to one.

E codes also require additional staff work in your office to look up and document the appropriate code.