On Feb 26, 2018, Delmarva Foundation, Health Integrity, Quality Health Foundation, and Quality Health Strategies came together under a new name: Qlarant.  The following content was created prior to this change and may contain our old name(s).  Learn More

There’s a Code for That!

With the implementation of ICD-10 in October 2015, the number of potential diagnosis codes expanded from 13,000 to 68,000. One category of codes that received an extensive overhaul was the external cause codes. These codes are most often used in conjunction with codes from Chapter 19 of the ICD-10 code book: Injury, Poisoning and Certain Other Consequences of External Causes. By adding external cause codes to a claim for services, the provider is painting a complete picture of why the patient presented for care.

If “Mrs. Smith” presents to the Emergency Department with a broken hip after slipping in her shower, the provider should indicate how it happened. Code W18.2XA reports falling in the shower and code Y92.012 would further clarify that it “happened in the bathroom of a single family residence”. Another example would be little “Johnny Smith” who presents at an urgent care center with a fractured wrist. He was skateboarding around his neighborhood and collided with a car. Code V03.12XA reports “pedestrian on a skateboard injured in collision with car” and Y92.414 reports that it occurred “on a local residential or business street”. Reporting the details of these injuries ensures clarity in the medical record. Analysis of these types of injuries has been used to develop safety campaigns. The use of hand rails and non-skid mats in showers is often recommended by primary care physicians and it is strongly suggested that skateboarders where protective gear to prevent wrist injuries.

While these examples illustrate injuries that could possibly be prevented with the use of safety precautions, there are also codes to report random accidents. If you are knitting and manage to puncture your finger with one of the needles, code Y93.D1 covers that painful mistake. How about a bad paper cut? W26.2XXA covers “contact with edge of stiff paper”. Did you go to a petting zoo and get bitten by a grumpy goat? W55.31XA reports that incident no matter the mood of the goat.

These situations may seem silly, but the additional information these codes can provide help insurance companies or other payors. By providing the details needed to process claims without having to request actual records, ICD-10 codes shorten and reduce the cost of the entire process.

Thanks for visiting. I hope reading this didn’t cause code H53.10, “unspecified subjective visual disturbance”!

about the author

A portrait of Cindy Jones

Cindy Jones is a coding instructor for Qlarant, as well as a certified medical auditor assisting the medical review staff with integrity audits. See all posts from Cindy Jones.

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