This podcast will cover the external
causes of morbidity category V00-Y99.
This corresponds to
Chapter 20 in the code book. While
external cause codes are most applicable
to injuries, they are also valid for use
with such things as infections due to an
external source and health conditions
such as a heart attack that occurs
during strenuous physical activity. The
external cause code follows the patient
as long as the patient is receiving
treatment for the condition. The
assignment of the 7th character for
external cause codes should match the
7th character for the associated
injury or condition. Here's an
example where we see this. An orthopedic
office follow up- patient's returning to
have external fixation pins removed.
X-rays indicate the ulna is healing and
we see with the first code, the 7th
character "F" is a subsequent encounter
the next code S55.-, the injury to the
blood vessel, also a subsequent encounter
and W30.9xxD contact with
agricultural machinery, a 7th
character "D" for subsequent encounter.
Now you notice because it's a subsequent
encounter, we are not seeing the place of
occurrence or the activity external
cause codes. They are only used for an
initial encounter. The guidelines tell us
to use the full range of external cause
codes assigning as many as necessary to
fully explain the cause of something- the
cause, the intent, the place of encounter,
sorry, the place of occurrence, the
activity, and the status.
Eexternal cause codes can never be the
principal (diagnosis). They are being used to explain
the cause or the why of the injury.
That injury is usually the principal diagnosis.
Some combination external cause codes
correspond to the sequence of events
which caused the most serious injury. For
example, a fall, and the person hit their
head after they fell and the hitting of the
head after they fall is the most serious
consequence that would be captured in a
combination code. No external cause code
is needed if the external cause is
included, for example, poisoning by
penicillin. That is in your T36.0X1-
code so you do not need an external
cause code.The place of occurrence is
only reported during the initial
encounter. There's no 7th character
for Y92. You do not use Y92.9, which
is unspecified, if the place is not
stated. More reminders about the activity
external cause code. It's only reported
once and that is during the initial
encounter; Activity codes are not
applicable to poisonings, adverse effects,
misadventures or sequelae. You do not
assign Y93.9 if the activity is not
stated. It is appropriate to report
activity codes if it provides additional
information. When applicable, place of
occurrence, activity and external cause
codes are sequenced after the main
external cause codes. There are many
guidelines in Chapter 20 to help the coder
with sequencing, so I would encourage you,
if you ever find yourself in a situation
where you've got all these external
cause codes, immediately go to your
guidelines and look for some guidance
there as to how to sequence those. Here's
an example where the patient was hit
during the hurricane, debris fell on him. That gives you the fracture code. The "P"
is a 7th character, the subsequent
encounter for a closed fracture
with malunion. We also are going to use
the forces of nature, the hurricane with
the "D" as a 7th character and struck
by object falling
W20.8xxD for subsequent encounter. We
do not code the place of occurrence.
Sometimes the reporting format limits
the number of external cause codes that
a coder can assign so you will report
the external cause code that is most
related to the principal diagnosis. If
the format permits you to code
additional codes, you're going to capture
any external cause codes before you're
going to report place of occurrence,
activity or external status. This is a
coding guideline, so again, if you ever
find yourself with multiple external
cause codes and you have limited (space due to the) format,
go to your guidelines to see how to
sequence those. There are also guidelines
with respect to child and adult abuse,
unknown or undetermined intent,the
sequelae of external cause, terrorism and
external cause status codes. Please go to
your guidelines whenever you come up
against any of those. This very short
podcast did not cover all the guidelines
for Chapter 20. Please look at those in
the front of Chapter 20 in the code
book. Read through those guidelines. Let
me know if you have any questions. Thank
you very much.