Review Three Coding Challenges for Reporting

Injuries
By Susan Dooley

Physicians of almost every specialty care for patients injuries ranging from the mundane (S60.031A,
Contusion of right middle finger without damage to nail, initial encounter) to the more serious
(S48.122A, Partial traumatic amputation at level between left shoulder and elbow, subsequent
encounter). Have you and your providers mastered the complexity of ICD-10-CMs injury coding rules?

Three Coding Challenges for Reporting Injuries

Injury diagnosis coding offers three unique challenges:
1. The seventh character extender
There are some complete ICD-10-CM codes that are only three digits (I10, Essential hypertension), but
you wont find many of those in the injury chapters. Coding for injuries with ICD-10 requires aseventh
character to indicate the episode of care. That means you assign a seventh character to indicate
whether your provider is seeing the patient for this injury for active treatment, for a followup from the
initial injury, or because of long-term after effects or sequela from the original injury. Fracture reporting
offers even more of the alphabet in the extender.

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
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2. The placeholder X
Speaking of that seventh character, what happens if the rest of the code is only 5 characters? When the
guidelines said the episode of care letter goes at the seventh space, they werent kidding. Placeholder
X comes in handy when you have to report a code like S82.61XA (Displaced fracture of lateral
malleolus of right fibula, initial encounter for closed fracture).
3. Three optional occurrence codes.
When you report injuries, you may need to use a secondary external cause code to describe how the
injury occurred. This isnt a big change from ICD-9, where some payers required E codes. However, ICD10 also offers three additional optional occurrence codes for your reporting pleasure.

A Look at External Cause and Place of Occurrence Codes

At this point, Id be surprised if most coders werent masters of the seventh digit and its pal, placeholder
X. Its true, though, that some were confused initially by the episode of care concept of A, D, and S,
probably because they tried to make it correspond to the CPT definition of new and established
patients.
But those external cause and place of occurrence codes these deserve a second look if only because
theyve been the butt of every ICD-10 joke since the new diagnosis coding system was announced.
(Heres one of my own accountings of weird yet wonderful external cause codes.) Can you even count
how many times you heard the ICD-10 haters chortle about W22.02XS (Walked into lamppost, sequela)?
The thing is, external cause codes can offer important public safety information for researchers who are
trying to figure out how to prevent accidents. So though some of these codes seem silly, they arent
really a joke. Again, much like the ICD-9s E codes, ICD-10s external cause of morbidity (V00-Y99) codes
are optional with most payers. If your payers required E codes back in the olden days, no doubt they still
want V, W, and Y codes with ICD-10. Just dont ever report an external cause code as the first listed,
because these can never be principal diagnoses.
Finally, the additional three occurrence codes are also optional. These codes are used to tell where the
patient was when the injury occurred, what she was doing (though in some cases this is redundant to
the external cause code), and whether the injury occurred while at work, in the military, or as a civilian
doing a volunteer activity.

Check Out This External Cause and Occurrence-Laden Scenario

Well close with a quick scenario. While strolling through a state park one day and simultaneously
staring at her smartphone screen, Susan accidentally walked into a tree branch where a turtle was
sunning itself. Startled, the turtle fell off the branch and scurried away, first scraping Susans left wrist
with its claws. She suffered an abrasion. Heres how youd report that story. Remember, the only
required diagnosis code (depending on your payer) is the first one.

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

S60.812A, Abrasion of left wrist, initial encounter

W59.22XA, Struck by turtle, initial encounter
Y92.830, Public park as the place of occurrence of the external cause
Y93.01, Activity, walking, marching and hiking
Y93.C2, Activity, hand held interactive electronic device

What About You?

Do you ever get to use the external cause codes with your payers? Im curious! Let us know.

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Contact Us:
Name: Sam Nair
Title: Associate Director
Email: shyamn@codinginstitute.com
Direct: 704 303 8150

Desk: 866 228 9252, Ext: 4813

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com