Question Place of Occurrence Y92

nyckimmie

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Hello, I love to hear anyone's take on Y92 guideline "Generally, a place of occurrence code is used only once, at the initial encounter for treatment". Coder was dinged on audit for reporting Y92.810 Car as place of Occurr. additionally w/fracture code S62.336A. The encounter was ambulatory surgery (facility coding) after the pt. had been seen at clinic a few days ago. My thought is 7th character A is initial encounter (surgery is an example of active treatment), therefore adding a place of occurr. is appropriate. anyone agree or disagree and why. thanks for any feedback.
 

Orthocoderpgu

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I have been in this business a long time and am generally "Old School" in my thinking. The thought process is that whoever sends in the first bill for the diagnosis and possible treatment of a fracture should add the occurrence codes so the insurance can rule out the need for another insurance to pay. Subsequent billing would not need the occurrence codes since they were already on file with insurance. However, I would not link using occurrence codes to the seventh character A either. Having said that I don't see why a coder would be dinged on their audit for using occurrence codes either. With the change from moving from ICD.9 to ICD.10 reporting occurrence codes more than they previously were is actually encouraged. I understand that they rule is that Y92 is "Generally" used only once, does not mean that it's a hard and fast rule either. Another coder probably coded the initial treatment encounter and may have not used an occurrence code either. I would not have given the coder an error. The other reason for not giving an error is the that these codes are "informational", they do not impact payment. If you look under guidelines #2 coders are encouraged to use the External Cause codes for the "duration of treatment". This is not an error on the coders part.
 
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thomas7331

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The guidelines actually explicitly say that this is not error unless the organization has internal guidelines requiring the assignment of these codes. Per the ICD-10 Chapter 20 guidelines for code range V00-Y99:

"There is no national requirement for mandatory ICD-10-CM external cause code reporting. Unless a provider is subject to a state-based external cause code reporting mandate or these codes are required by a particular payer, reporting of ICD-10-CM codes in Chapter 20, External Causes of Morbidity, is not required."

So I agree with Orthocoderpgu, I would not have assigned an error unless the provider or facility had instructed me that their coding policies require it.
 
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such78

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ICD-10-CM Official Guidelines for Coding and Reporting FY 2021 (October 1, 2020 - September 30, 2021):

Place of Occurrence Guideline Codes from category Y92, Place of occurrence of the external cause, are secondary codes for use after other external cause codes to identify the location of the patient at the time of injury or other condition. Generally, a place of occurrence code is assigned only once, at the initial encounter for treatment. However, in the rare instance that a new injury occurs during hospitalization, an additional place of occurrence code may be assigned. No 7th characters are used for Y92. Do not use place of occurrence code Y92.9 if the place is not stated or is not applicable
 
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