Hello, I'm an Educator for Outpatient facility coding and need some feedback on interpreting POO guideline ch 20.b ...POO is assigned only once, at the initial encounter for treatment... We code for ambulatory surgeries, for example orif CPT 25545 of fx S52.571A; while playing soccer W21.02XA, on a soccer field Y92.322 (as documented in H&P from the day prior to surgery). The injury occurred 4 days prior and now presents for treatment/ surgery. One point of view is 7th character A means initial encounter and Y92.322 would be reported. Another point of view is this is not the initial encounter and Y92.322 would not be reported. I anyone would comment on if Y92.-- would be reported or not, I would appreciate it. thank you.
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- Thread starter nyckimmie
- Start date
thomas7331
Guest
In my opinion, it's really up to your organization to make this decision. Guidelines state that the use of external cause codes is encouraged but not mandatory, so in my opinion this is entirely at your discretion. The organizations I've worked for have required the external cause code when an injury is reported, but have not required the place of occurrence, activity or status codes. If you know that some of your payers require the codes, or if you feel it's important information to report, for example on a work comp claim, I'd certainly include it, but if not then I would not burden your coders or providers with the requirement, nor penalize them for omitting it.
As for only assigning it once at the initial encounter, the exact language of the guidelines is vague, stated that it is "generally" only assigned once, which by my reading doesn't mean it is prohibited to assign it on subsequent encounter, and again, if you have reason to believe that the payer wants it, then I'd certain not hesitate to add it.
As for only assigning it once at the initial encounter, the exact language of the guidelines is vague, stated that it is "generally" only assigned once, which by my reading doesn't mean it is prohibited to assign it on subsequent encounter, and again, if you have reason to believe that the payer wants it, then I'd certain not hesitate to add it.
OpenClaims
Guest
My opinion is that the POC should be reported any type that the documentation for causation in regards to the injury is present. When coding an injury in an encoder, it will always prompt that you include any external causes and/or places of occurrence. This also helps to ensure that the facts surrounding the injury are present.
amyjph
True Blue
I agree with both opinions. In my experience, this is a decision made internally in organizations. In some cases, especially for work comp or auto, it may be required by the payer. It definitely helps to explain when it is reported. It's probably not going to make a difference from a revenue/claim perspective whether those additional codes are reported or not for the surgery unless the payer specifically requires it.
It has value from an internal data analytics perspective if you wanted to track mechanism or location of injury for some reason internally. However, that may be something that could be mined directly from the EHR another way (besides codes).
It has value from an internal data analytics perspective if you wanted to track mechanism or location of injury for some reason internally. However, that may be something that could be mined directly from the EHR another way (besides codes).