Injury causes are important and about to get more so, but they still come after the type of injury when coding. This taxonomy has caused confusion in some organizations, resulting in rejected claims. In ICD-9, when submitting an injury claim, the injury must be listed first, and the cause listed second. This order will remain in ICD-10.
It’s important for coders and clinicians to understand the rules:
- E codes, which describe external causes, cannot be used as the principal diagnosis.
- E codes are used to describe both the activity of the injured person and all health conditions related to the injury. Coders are asked to use as many E codes as needed to describe the place of occurrence, the cause, and the intent.
- Most payers will reject an injury code submitted without a cause.
In ICD-10, injury coding will add a seventh digit extender for injury code. The seventh character will be as follows for injury codes: initial encounter (A), subsequent encounter (D), sequela (S)
An initial encounter code is used typically for an emergency department visit, an initial physician evaluation and treatment, or a surgical treatment. When a patient receives follow-up care during their recovery or healing phase, a subsequent code is used. If complications or unforeseen conditions arise as a result of the injury, a sequela code is used.
Importantly in ICD-10, providers must report the external cause of the injury at every visit for the condition. For the first visit, the provider must report on
- The activity the patient was engaged in,
- The place of occurrence, and
- Whether the patient is a civilian or in the military.
As always, the key to getting injury coding right is awareness and training. Coders should receive clear instructions about ICD-10 rules for this area, and clinicians should begin asking patients how/where their injury occurred and if they’ve been previously treated for it.