by Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA
If working the edit list from your state reporting agency makes you feel like you’re on a merry-go-round, it may be time to offer them your help in refining their external cause code submission requirements.
Chapter 19, Injury, Poisoning and Certain Other Consequences of External Causes is a far more detailed set of codes in ICD-10-CM than it was in ICD-9-CM. The system itself identifies that things are different now through the use of an Informational Note at the beginning of the chapter. It says: “Use secondary code(s) from Chapter 20, External Causes of Morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause code.” It’s obvious that the codes found in the Table of Drugs and Chemicals have the external cause included in the description, but what about the many other codes that are very specific in ICD-10-CM? Here are a few examples:
T71.113 Asphyxiation due to smothering under pillow, assault
T81.32 Disruption of internal operation (surgical) wound, not elsewhere classified
T82.856 Stenosis of peripheral vascular stent
T85.43 Leakage of breast prosthesis and implant
Each of these codes tells you what happened and how it happened, making the additional external cause redundant. My clients tell me that these types of codes comprise the vast majority of the edits and these are the types of codes referred to in the Informational Note. If handling these repeat edits is becoming overwhelming, it seems to me that there is an alternative to struggling through the rework. Why not go to the source of the data collection edit and explain that the requirements might need refinement for the ICD-10-CM code set. After helping one client to prepare for just that meeting, I thought it might help others if I shared my data collection recommendations with all of you.
There are three types of codes included in Chapter 19. My recommendations for data collection for each code range are
|Code Range||External Cause Code (Chapter 20) Requirement|
|S00 to T34||Required|
|T36 to T65||Not Required|
|T66 to T88||Optional – Assign Chapter 20 code if additional cause information is documented|
In addition, coders should review the code blocks of Y62-Y69 and Y70-Y84 for codes. These codes can be assigned to add specificity for any documented details about the abnormal reaction due to a surgical or medical procedure, type of misadventure or medical device related to the injury in categories T66 to T88.
Let’s discuss other external cause codes located in Chapter 20. Some state reporting agencies mandate reporting the Place of Occurrence and Activity external cause codes whenever a S00-T88 category is reported. Many facilities choose to assign Y92.9 and Y93.9 to meet their state’s reporting requirements while others do not in an effort to remain compliant with the Official Guidelines for Coding and Reporting. Although codes exist for unspecified Place of Occurrence and Activity, the Official Guidelines for Coding and Reporting instruct coding professionals not to assign Y92.9 and Y93.9 if the place and activity are not stated.
Talk with the person who is responsible for the data submission at your facility to discuss this issue and work with them to establish contact with the agency to which your data is sent. Your state hospital association may be this agency, or may help you in a combined effort to modify the data requirements for your state.
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