Medical Coding Review: ICD-10-CM External Cause Codes of Morbidity

Can you please review External Cause Codes or “E-Codes” in Medical Coding for ICD-10-CM?

Yes, some people like to say, “Well, E-codes will go away in ICD-10” – well, they’re just not called E-codes anymore since ICD-10 was introduced. They don’t really go away, they’ve just expanded. They’re more in-depth like the rest of ICD-10 is. E-codes, yes, you could say they’ve gone away, or let’s just say they’ve been updated and revised a little bit, they tweaked them.

E-codes are now classified as External Causes of Morbidity, (V00-Y99). Chapter 20 in the 2021 ICD-10-CM Code Books.

The basics about External Cause codes, if you’re not familiar with them, they’ve got some guidelines.
Here are some highlights of the guidelines:

1. An External Cause code may be used with any code in the range of A00.0-T88.9, Z00-Z99 which indicates an injury, poisoning, or adverse effect due to an external cause.
2. Assign the appropriate External Cause code with the appropriate 7th character (initial encounter, subsequent encounter, or sequela) for each encounter for which the injury or condition is being treated . 
3. Use a late effect external cause code for subsequent visits when a late effect of the initial injury is being treated. 
4. Use the full range of external cause codes to completely describe the cause, the intent, the place of occurrence, and if applicable, the activity of the patient at the time of the event, and the patient’s status, for all injuries, and other health conditions due to an external cause.
5. External cause codes should never be sequenced as the first listed or principal diagnosis. Again, there are chances where you might have to use more than one external cause code, that’s been known to happen.
6. Assign as many external cause codes as necessary to fully explain each cause. If only one external cause code can be recorded, assign the external cause code most related to the principal diagnosis.
   
   If you get on YouTube sometimes, there are some funnies about external cause codes and the descriptions of them. I can’t think of any multiple external cause codes just right off the top of my head; but if a person was walking across the street and got hit by a bike and then turned around and got hit by a bus. There are actually two separate external cause codes for that.
7. The selection of the appropriate external cause codes are guided by the Index to External Causes of Injuries which is located after the Table of Drugs and Chemicals– I would tab it in my manual, your External Cause Codes Index.

External Causes of Injuries Explained

What type of categories would we see that we would expect to use an external cause code? I made a list of those.

• Transport accidents – that’s talking about you’re riding your bike and you fell off your bike and you broke your arm. You are a passenger on a bus in the movie – what was that movie where the lady couldn’t slow down on the bus? And so, you got dehydrated because you had to stay on the bus for 24 hours. You couldn’t eat nor drink anything. Transport accidents – it could be a bike, it could be a vehicle, it could be an airplane; anything that transports you from one place to another place.
• Poisoning and adverse effects of drugs, medicinal substances, and biologicals – Poisoning because you had taken a medication that the doctor prescribed to you, but you accidentally took it in the wrong way, not the way it was listed on the label. Or, you took the medication the way it was prescribed but you had an adverse effect and you broke out in hives. This also could be poisoning because you went to go collect some healthy salad makings out in the woods because you read a book about it or saw it on YouTube and you end up eating poison ivy, which could be a really bad thing. That would be poisoning.
• Accidental falls – they have that broken down pretty specifically.  Did you fall going up the steps, did you fall going down the steps? Did you fall because someone accidentally pushed you? Did you slip on the carpet? Did you slip on the ice? It just goes on and on and on. If it’s happened, there’s a code for it.
• Accidents caused by fire and flames – that’s pretty diverse. Accidents caused because you were starting a fire, in your fireplace at your home, or let’s say you have a gas stove and you caught your sleeve in it. Or you had a can of hairspray and you went to spray somebody’s hair and they were smoking a cigarette, poof! There are all kinds of accidents with flame.
• Accidents due to natural and environmental factors – you could slip and fall on the ice because it’s icy, or you slip and fall off a cliff, again environmental factors.
• Late effect of accidents, assaults, or self-injury – you jumped off a building, you were attacked and mugged and you had an accident and busted your leg.
• Assaults or purposely inflicted injury – there was one that always got the students that were in the Carol Buck book. I don’t know if it’s still there, but it was such a great one. A person was poisoned with snake venom in their drink and it ended up being an assault code that they put in there. How do you know it was an assault? The book explained that people don’t put snake venoms in drinks for just no reason. It was an assault! I’ll never forget that one.
• Suicide or self-inflicted injury – there are many different ways. Jumping off of a building for example. 

Differences Between E-Codes and The External Causes of Morbidity in ICD-10

Now, let’s look at the differences between E-codes and the External Causes of Morbidity in ICD-10. It’s going to be V00 through Y99. It’s just, they’ve changed the codes and they’ve expanded the codes. So, I came up with an example and I didn’t have time to pull a picture of Mr. Greenjeans, but I may be dating myself a little bit for however many of you remember Mr. Greenjeans. He fell from a barn roof – that’s all the information we’ve got. We don’t know what was going on, we just know he fell from the barn roof.

In ICD-9 that would be E987.1 – falling from a high place, undetermined whether accidentally or purposely inflicted; other man-made structures. Because they have a residence, a barn would not be a residence, a barn is “other man-made structure.” There’s another code if it’s commercial property. So, you’ve got residential, other man-made, or a commercial building. That seems pretty diverse to me. That captures a lot.

But ICD-10 gives the same information, but on steroids. Now, a little hint though, you know you’ve got these GEMs and crosswalks that you can use where you can type in the ICD-9 code and get the ICD-10 code, you can type in 401.9 for essential hypertension and you’ll get I10. Or you type in I10 and you’ll get all three of the hypertension codes – malignant, benign, and essential. So, you can do that. You can’t really do that with external cause codes because they’re so diverse in ICD-10, they don’t match, they don’t map.

Here you go. The same codes are pretty close to the equivalent. Here are our choices in ICD-10, we have W13, they’re all W13s. We’ve got W13.0 – W13.9. We’ve got fall from, out of, or through balcony. We’ve got fall from, out of, or through bridge. We’ve got fall from, out of, or through a roof. Fall through floor. Fall from, out of, or through window. Fall from, out of, or through other building or structure, and fall from, out of, or through building, not otherwise specified.

Mind you, this can be broken down even more and there are other codes that maybe would even be more descriptive. I looked for a code for a fall and not saying it’s residential, not saying whether it’s… Actually, I think, don’t quote me on this, but I think these were all the ones that came up for it’s not residential, it’s not commercial; so a man-made structure. These are all the ones that could have come through a man-made structure.

We know he fell from the roof, so maybe W13.2 might be the best one. Or, he could have fallen through the window, in the front of the barn. I don’t know, we didn’t get enough information, I guess, but it said “roof.”

Interesting, isn’t it? Just really, really diverse. Now, this is one little aspect, there’s actually even more diversity with these where you can do more codes. Maybe we’ll reflect on that in the future and give a more detailed scenario where it’s not just the physical fall. You can code the whole picture with ICD-10, for example, what he had for lunch that day. You know, a baloney sandwich and – I’m just kidding.

Anyway, it’s a lot of fun to look at the External Cause codes.