September 22, 2014

Yes, There’s a Code for That

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You have probably read the stories and heard the jokes regarding the fact that ICD-10 has a code for everything. Some are humorous, such as the notion that there are codes for walking into a lamppost or being burned while on flaming water skis, or even my favorite, being injured while knitting. Some are scary, raising questions about the intricacies of trying to code out where the patient was, what he or she was doing, and whether he or she was working at the time in order to assign all the codes necessary for injury coding with external causes.

 

Interestingly enough, we have many of these codes in ICD-9-CM. Most of us just don’t have to use them. Why all the new attention? It’s simple: the shock and awe factor. If you can be made to feel like the codes are overwhelming or inappropriate, then chaos can be caused in the industry and derail us from the task at hand.

I can’t tell you how many times I have seen these codes misrepresented by individuals who just don’t understand the use or purpose of them.

External cause codes are intended to provide data for injury research and evaluation of injury prevention strategies. These codes capture how an injury or health condition happened (the cause), the intent (whether an injury was unintentional, accidental, or intentional, such as the result of a suicide or assault), the place (where the event occurred), and the activity of the patient at the time of the event. They also can help us achieve correct processing of claims the first time, thus alleviating administrative burdens in the long term.

Keep in mind that these codes are only used at the initial encounter, and many health plans do not require the reporting of external cause codes. Unless you are working in an urgent care or emergency department, it is rare that you will use these codes to this level of detail.

The use of all these codes can actually help simplify the reimbursement process. If you can spell out to a health plan exactly what the patient was doing, where they were, and whether they were working when an injury occurred, the adjudication process can become more immediate. Claims will not need to be subrogated while additional information is requested from the patient or provider.

Imagine being able to spell out via a claim form the who, what, when, where, and why of an injury. For example:

Janie was rushed to the emergency department after sustaining injuries from a motor vehicle accident in her pickup truck; she was texting and driving and struck the car in front of her on a rural street. She has contusions on her forehead as well as some bruising on her right chest due to the airbags in her vehicle deploying.

The coding would look like this:

S00.83XA Contusion of other part of head

S20.211A Contusion of right front wall of thorax

V53.5XXA Driver of pickup truck or van injured in collision with car, pickup truck or van in traffic accident, initial encounter

W22.11XA Striking against or struck by the driver side automobile airbag, initial encounter

Y92.414 Local residential or business street as the place of occurrence of the external cause

Y93.C2 Activity, handheld interactive electronic device

With one claim submission we are able to indicate to the health plan that the patient suffered injuries due to texting and driving on a residential street and that she struck the other car.

So keep in mind, while there might be a code for that, many times it may not apply to your situation. Don’t become overwhelmed with the codes, but rather remember that their correct use can help your claims get adjudicated without suffering additional administrative burdens along the way.

As always, take what you read with a grain of salt before reacting and ask yourself: how does that really apply to my practice?

Rhonda Buckholtz, CPC, COPC, CPMA, CPCI, CHPSE, CRC, CDEO, CGSC, CPEDC, CENTC

Rhonda Buckholtz is the vice president of practice optimization for Eye Care Leaders. She has more than 25 years of experience in healthcare, working in the management, reimbursement, billing, and coding sectors, in addition to being an instructor. She is a past co-chair for the WEDI ICD-10 Implementation Workgroup, Advanced Payment Models Workgroup and has provided testimony ongoing for ICD-10 and standardization of data for NCVHS. Rhonda spends her time on practice optimization for Eye Care Leaders by providing transformational services and revenue integrity for Ophthalmology practices. She was instrumental in developing the Certified Ophthalmology Professional Coder (COPC) exam and curriculum for the AAPC. Rhonda is a member of the ICD10monitor editorial board and makes frequent appearances on Talk Ten Tuesdays.