Wiki External cause codes

[nbohannan85]

If a patient is seen for left wrist pain from tripping and falling, but there are no acute findings of a fracture or injury in the X-ray; would I code M25.532 with the external cause code W01.0XXA or M25.532 with Z04.3 (encounter for exam/observation following other accident)? Are the external cause codes only to be used with injury codes?

 

[mitchellde]

You can use the external cause codes in conjunction with any code. At the beginning of the M chapter is the following note
Note:
Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition

You can use the Z04.3 code but it must be the first listed code then the code for the wrist pain and last the external cause code

 

[nbohannan85]

You can use the external cause codes in conjunction with any code. At the beginning of the M chapter is the following note
Note:
Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition

You can use the Z04.3 code but it must be the first listed code then the code for the wrist pain and last the external cause code

Thank you for your help

 

[Cynthia Hughes]

I would offer one caveat to this conversation. Because the patient had wrist pain (a health condition or mild injury not requiring treatment) from the fall, it is appropriate to report the code for the pain and the external cause even though no fracture, dislocation, or other specific injury was diagnosed. However, if the patient had presented following a fall with no complaint and no injury found (as often happens with small children), you would not report an external cause code. Coding Clinic addressed this question in 2018 Vol. 5, No. 2 saying that, "Answer: The external cause code indicates an injury, health condition or adverse effect has occurred, and these codes are not assigned without a documented injury, health condition or adverse effect."