Basic ICD10 CMPCS Coding 2013 edition Chapter 23

Learning Objectives • Review the chapter’s learning objectives and key terms • At the

External cause of injury codes in ICD-10 -CM V 00 –Y 99 • External cause codes start with characters V, W, X, and Y • This chapter classifies external causes defined as environmental events and circumstances that cause injuries and other adverse effects © 2013

External cause of injury codes in ICD-10 -CM V 00 –Y 99 • Codes capture the cause of injury or health condition, the intent (unintentional or accidental; or intentional, such as suicide or assault), the place where the event occurred, the activity of the patient at the time of the event, and the person’s status (namely, civilian, military) © 2013

External cause of injury codes in ICD-10 -CM V 00 –Y 99 • External cause codes cannot be assigned as: o Principal diagnosis codes o First-listed diagnosis codes o Only listed diagnosis codes • External cause codes are used as secondary codes with a code from another chapter that indicates the nature of the condition © 2013

External cause of injury codes in ICD-10 -CM V 00 –Y 99 • Most often an external cause code is used with injury and certain other consequences of external cause codes from Chapter 19 of ICD-10 -CM • Other conditions may be stated to be due to external causes classified in Chapters 1 to 18 • The external cause codes provide additional information as to the cause of the condition © 2013

External cause of injury codes in ICD-10 -CM V 00 -Y 99 • Coding external causes of injuries and other conditions provides valuable data for research and evaluation of injury prevention strategies • External cause codes provide valuable information to public health agencies and may assist health planner in determining the kind of accidents a particular facility or physician treats © 2013

External cause of injury codes in ICD-10 -CM V 00 -Y 99 • Use of external cause codes is optional for many physicians and healthcare facilities • State governments have mandated the use of some or all of the types of external causes to be reported • Other states require the reporting of external causes by certain providers, such as hospitals that are regional trauma centers © 2013

Coding Guidelines and Instructional Notes for Chapter 20, External Causes of Morbidity • New notes have been added to show which categories require the 7 th character to indicate whether the episode of care being identified was the initial, subsequent, or the condition is a result of an event or sequelae • The 7 th character to be added are: A—Initial encounter D—Subsequent encounter S—Sequela © 2013

Coding Guidelines and Instructional Notes for Chapter 20, External Causes of Morbidity • Three other external cause codes identify other factors concerning the external event o Y 92 Place of occurrence of the external cause o Y 93 Activity codes o Y 99 External cause status © 2013

Coding Guidelines and Instructional Notes for Chapter 20, External Causes of Morbidity • Category Y 92, Place of occurrence of the external cause, is used in conjunction with activity code • The activity code from category Y 93 indicates the activity of the person seeking healthcare for an injury or health condition • The external status code from category Y 99 indicates the status of the person at the time the event occurred © 2013

Coding Guidelines and Instructional Notes for Chapter 20, External Causes of Morbidity • Chapter-specific guidelines were published for Chapter 20 addressing General external cause coding guidelines Place of occurrence guideline Activity code Place of occurrence, activity, and status codes used with other external cause code o If the reporting format limits the number of external cause codes o o © 2013

Coding Guidelines and Instructional Notes for Chapter 20, External Causes of Morbidity • Chapter-specific guidelines were published for Chapter 20 addressing o o o Multiple external cause coding guidelines Child and adult abuse guideline Unknown or undetermined intent guideline Sequela (Late effects) of external cause guidelines Terrorism guidelines External cause status © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • External cause codes can never be listed first or as the only diagnosis code reported • External cause codes are used as a secondary code with another code from other chapters in ICD-10 -CM © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • The codes with the appropriate 7 th character is assigned for each encounter for which the injury or condition is being treated o Initial encounter o All subsequent encounters o Sequela situations or later in time when the patient continues to suffer from the consequences of the original problem that was caused by an external event © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • External cause codes completely describe the o Cause o Intent o Place of occurrence o If applicable, the activity of the patient at the time of the event o If applicable, the patient’s status at the time of the event © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • As many external cause codes are assigned as necessary to fully explain each cause • If only one external code can be reported, the coder should assign the code most related to the principal diagnosis © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • No external cause code from Chapter 20 is needed if the external cause and intent are included in a code from another chapter • For example, an external cause code is not used with a code for a poisoning because the intent of the poisoning is included in that code © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • Certain external cause codes are combination codes that identify sequential events that result in an injury • For example, a fall that results in striking against an object. The injury may be due to either event or both. The combination code should correspond to the sequence of events (fall, then strike) regardless of which event caused the most serious injury © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • ICD-10 -CM indicates when one of the external cause codes requires a 7 th character of initial (A), subsequent (D), or sequela (S) • Because the external cause code is assigned for each encounter when the injury or condition is treated, the 7 th character identifies the timing of the care of the injury or condition © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • Certain external cause codes are only used once at the initial encounter for treatment o Place of occurrence codes o Activity codes o External status codes • The 7 th character must be in the seventh position in the data field. If necessary, a placeholder X is used to fill the empty characters when a code is less than 6 characters © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • Place of occurrence, activity and status codes are sequenced after the main external cause code(s) • Only one place of occurrence, one activity and one status codes are assigned to the initial encounter • During subsequent visits for care, only the external cause code will be assigned with the 7 th character of D © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • The first-listed external cause code should correspond to the cause of the most serious diagnosis due to an assault, accident, or self-harm, following an established hierarchy • If two or more events cause separate injuries, an external cause code should be assigned for each cause © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • The first-listed external cause code will be selected in the following order o Child and adult abuse take priority over all other external cause codes o Terrorism events take priority over all other codes except child and adult abuse o Cataclysmic events take priority over all other codes except child and adult abuse and terrorism o Transport accidents take priority over all other codes except cataclysmic, child and adult abuse, and terrorism o Activity and external cause status codes are assigned following all causal (intent) external cause codes © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • Adult and child abuse, neglect and maltreatment are classified as assault • For cases of confirmed abuse and neglect is documented in the record, an external cause code from the assault section (X 92 -Y 08) should be added to identify the cause of any physical injuries • For confirmed cases, when the perpetrator is known, a code from Y 07, Perpetrator of maltreatment and neglect, should accompany other assault code • For suspected cases of abuse and neglect, no external cause of injury and perpetrator code for the encounter is assigned © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • All transport accident categories are assumed to be accidental and reported as having an accidental intent • If the intent of an event is unknown or unspecified, that is, not stated as accidental, self-harm or an assault, the coder can assume the intent of the event is accidental • The only time a coder uses the event codes that state there is an undetermined intent is when the documentation specifically states the intent of the event cannot be determined © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • Sequelae or late effect external cause codes • External cause code is reported with the 7 th character of S for sequela • These codes should be used with any report of a late effect or sequela resulting from a previous injury • A sequela external cause code should never be used with a related current nature of injury code © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • Typically, a patient with a sequela of a past injury or illness is coded as follows: o Residual effect or the condition the patient has at present, which is found in the Alphabetic Index to Diseases or Injures o Sequela or late effect or the condition the patient originally had that produced the residual effect found in the Alphabetic Index to Disease or Injuries under the term “sequelae” o External cause code for the original accident or event, found in the Index to External Causes, with the 7 th character of “S” for sequelae © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • The transport accident section (V 00–V 99) is structured in 12 groups • Land transport accidents reflect the victim’s mode of transport, and are subdivided to identify the victim’s counterpart or the type of event • The vehicle of which the injured person is an occupant is identified by the first 2 characters since it is seen as the most important factor to identify for prevention purposes. © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • A “use additional code” note appears under transport accident codes to use another code for o airbag injury (W 22. 1 -), o the type of street or road (Y 92. 4 -) o use of cellular telephone or other electronic equipment at the time of the transport accident (Y 93. C-) © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • National Quality Forum’s “Never Events” • External cause codes identify the occurrence of wrong site surgery, wrong surgery and wrong patient having surgery • IOM and NQF identified a list of “serious reportable events” that should never occur in healthcare © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • Example of external cause codes to identify these events o Y 65. 51 Performance of wrong procedure (operation) on correct patient o Y 65. 52 Performance of procedure (operation) on patient not scheduled for surgery o Y 65. 53 Performance of correct procedure (operation) on wrong side or body part © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • Some of these events can be captured with ICD-10 -CM diagnosis codes • Other events cannot be captured using ICD-10 -CM codes because the event is beyond the scope of the classification system, for example, an infant discharged to the wrong patient or the abduction of a patient of any age © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • Review the complete list of never events in the chapter’s table 23. 1: o o o Surgical events Product or device events Patient protective events Care management events Environmental events Criminal events © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • Military operations • Two categories of ICD-10 -CM external cause codes are available to report of cause of an injury or illness from military operations o Operations of War (Y 36) o Military operations (Y 37) © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • Terrorism external cause codes • Definition of terrorism employed by the FBI is in the inclusion note at the beginning of category Y 38 • More than one Y 38 code may be used • Suspected cases of terrorism are not coded with these codes © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • Place of occurrence (Y 92) • Identifies where the event occurred or the location of the patient at the time when the injury or other condition occurred • Used with an activity code if the activity is stated • Place of occurrence is only reported at initial encounter • Only one code from Y 92 should be recorded • If the place is not stated, no code is assigned © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • Activity code (Y 93) • Identifies the activity of the patient at the time the injury or other health condition occurred • Only used at the initial encounter • Only one code from Y 93 should be reported • Used with a place of occurrence code • No code is assigned if the activity is not stated © 2013

Coding External Cause of Morbidity in -10 -CM Chapter 20 ICD • External cause status (Y 99) • Assigned whenever any other external cause code is assigned • Indicates the work status of the person at the time the event occurred such as military person, nonmilitary person at work, student or volunteer • Not used with poisoning, adverse effect, misadventures or late effects. • Not assigned if status is not stated • Only reported at the initial encounter for treatment © 2013