External Cause Codes

tlm5506

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Coding conundrum....

If a procedure is done in an office or any other setting and the procedure is billed along with an E/M, should an external cause code be placed just with the E/M or should it be placed with both the E/M and the procedure code? For example, traumatic fracture is reduced in the office and there is also an E/M billed with the reduction code. Should the external cause code be placed with the reduction procedure code along with the fracture diagnosis code? The external cause code is already placed with the E/M, but why should it also be placed with the reduction procedure code?
 

thomas7331

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External cause codes are not required per ICD-10 guidelines, however some organizations or specific payers may require coders to include them when an injury is reported. If that is the case, then you would want to include the external cause code any time you are also reporting the injury code, so you would include it on every service for which you are also reporting the injury. I'm not sure what the rationale would be for reporting it on one service but not the other, since the two codes belong together - both codes report information that pertain to same condition. In your scenario here you are not reporting one service that is accident-related and one that is not.
 
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Orthocoderpgu

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I've been coding orthopedics for several years now. Thomas is correct, the external cause codes are optional but informational as well. They can let the insurance know that they can pay and not look to work comp or auto. We attach the external cause codes to the E/M only and never had an issue. They can be linked to both, so there is no wrong way.
 

tlm5506

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Thank you for the information. Let me add one other question....do you think it appropriate to get marked down on an audit for not putting an external cause code on a procedure code? I was marked down and I don't think it is appropriate.
 

thomas7331

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Thank you for the information. Let me add one other question....do you think it appropriate to get marked down on an audit for not putting an external cause code on a procedure code? I was marked down and I don't think it is appropriate.

I think that it your organization or auditor has written guidelines that the external cause code is required, then it would be appropriate to cite this as an error, but otherwise it is just one coder's opinion vs. another. If you've been given an error on this and you were never given direction that it is required, then you can rebut this by citing the guidance from ICD-10 that the external cause is not required.
 
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