Wiki No external cause code

[JVILLAS]

Hello,

I have a one year old patient who was dx with a "S" code for a sprain. Claim denied because no other external cause code which I understand..... the problem is there is no notation about how it happened. Considering a year old can't tell you "yeah I fell off the slide and no one was watching me". Also no notation on where it happened. Should I just use Y99.9 unspecified?

Thanks in advance

Jennifer

 

[amyjph]

Seems to be a query the provider situation. A child didn't come in alone, right? Who gave the HPI, parent? There's nothing in the note giving a story of what happened? Seems odd.

 

[JVILLAS]

No, just that the patient started limping and not bearing weight on one leg.

 

[amyjph]

Sounds like Y99.9 without seeing the chart. Seems nothing else to use.

 

[JVILLAS]

Yeah. Let’s see if the insurance pays the unspecified code.