ICD 10 Guidelines on External Cause Codes Presented by Ashley Yawn, BS, CPC April 17, 2018

Chapter 20: External Causes of Morbidity (V00 – Y99) Official Guidelines Medicare Guidelines Other payor guidelines AMA ICD10 Book Page 1358

General Requirements Never be sequenced as the first-listed or principal diagnosis. Intended to provide data for injury research and evaluation of injury prevention strategies. No National requirement for mandatory ICD-10-CM external cause code reporting.

20.a. General External Cause Coding Guidelines 20.a.1) Used with any code in the range of A00.0 – T88.9 & Z00-Z99 20.a.2) External cause code used for length of treatment 20.a.3) Use the full range of external cause codes 20.a.4) Assign as many external cause codes as necessary 20.a.5) The selection of the appropriate external cause code 20.a.6) External cause code can never be a principal diagnosis 20.a.7) Combination external cause codes 20.a.8) No external cause code needed in certain circumstances

20.b. Place of Occurrence Guidelines Category Y92, Place of occurrence of the external cause – secondary external cause codes. Only assigned once, at the initial encounter for treatment. No 7th character If place is not stated or not applicable, do not code

20.c. Activity Code Y93, Activity Code, describes the activity at the time of the injury Only assigned once, at the initial encounter for treatment. Not applicable to poisonings, adverse effects, misadventures or sequela. If activity is not stated or not applicable, do not code Appropriate for use with external cause and intent codes if provides additional information

20.d. Place of Occurrence, Activity and Status Codes Used with other External Cause Codes. Sequenced after main external cause code Generally only one of each per encounter: place of occurrence, activity, external cause status Rare instances of new injury during hospitalization

20.f. Multiple External Cause Coding Guidelines First Listed External cause code should correspond to the cause of the most serious diagnosis due to an assault, accident, or self-harm, following the hierarchy listed below. Priority Sequencing: Child and adult abuse Terrorism Cataclysmic events Transport accidents Activity and external cause status codes assigned after all causal (intent) codes

20.g. Child and Adult Abuse Abuse, neglect and maltreatment are all classified as assault. Only code if confirmed abuse If perpetrator is known, also code from Y07, Perpetrator of maltreatment and neglect.

20.h. Unknown or Undetermined Intent If the intent of the cause of injury is unknown or unspecified, code as accidental intent. All transports are assumed accidental intent. 20.h.1) Use of undetermined intent External cause codes for events of undetermined intent are ONLY for use if the documentation in the record specifies that the intent cannot be determined.

20.i. Sequelae (late Effects) 20.i.1) Sequelae external cause codes Reported with 7th digit “S” and should be used with any report of a late effect resulting from a previous injury. 20.i.2) Sequela external cause code with a related current injury Never used with a related current nature of injury code 20.i.3) Use of sequela external cause codes for subsequent visits Used when a late effect of the initial injury is being treated, not for subsequent visits for follow-up care of the injury when no late effect of the injury has been documented.

20.j. Terrorism Guidelines 20.j.1) Cause of injury identified by the Federal Government (FBI) as terrorism Code from Y38, Terrorism should be used as the firsts listed external cause code More than one Y38 code may be assigned if the injury is the result of more than one mechanism of terrorism 20.j.2) Cause of an injury is suspected to be the result of terrorism Do not code from Y38, suspected is coded as assault 20.j.3) Code Y38.9, Terrorism, secondary effects Conditions occurring subsequent to the terrorist event. It is acceptable to code from Y38.9 and another Y38 category if there is an injury due to the initial terrorist event and an injury that is a subsequent result of the terrorist event.

20.k. External Cause Status Code Category Y99 Should be used whenever any other external cause code is assigned for an encounter, except listed exceptions. Exceptions: poisonings, adverse effects, misadventures or late effects. Codes are used to indicate the work status at the time of the event. Ex: military activity, work, student, volunteer, etc. Do not use if no other external cause codes used Only used at the initial encounter If status is not stated or not applicable, do not code