20. Chapter 20: External Causes of Morbidity (V00-Y99) Flashcards
- Chapter 20: External Causes of Morbidity (V00-Y99)
- Chapter 20: External Causes of Morbidity (V00-Y99)
The external causes of morbidity codes should never be sequenced as the first-listed or principal diagnosis.
External cause codes are intended to provide data for injury research and evaluation of injury prevention strategies. These codes capture how the injury or health condition happened (cause), the intent (unintentional or accidental; or intentional, such as suicide or assault), the place where the event occurred the activity of the patient at the time of the event, and the person’s status (e.g., civilian, military).
There is no national requirement for mandatory ICD-10-CM external cause code reporting. Unless a provider is subject to a state-based external cause code reporting mandate or these codes are required by a particular payer, reporting of ICD-10-CM codes in Chapter 20, External Causes of Morbidity, is not required. In the absence of a mandatory reporting requirement, providers are encouraged to voluntarily report external cause codes, as they provide valuable data for injury research and evaluation of injury prevention strategies.
- a. General External Cause Coding Guidelines
1) Used with any code in the range of A00.0-T88.9, Z00-Z99 - Chapter 20: External Causes of Morbidity (V00-Y99)
1) Used with any code in the range of A00.0-T88.9, Z00-Z99
An external cause code may be used with any code in the range of A00.0-T88.9, Z00-Z99, classification that is a health condition due to an external cause. Though they are most applicable to injuries, they are also valid for use with such things as infections or diseases due to an external source, and other health conditions, such as a heart attack that occurs during strenuous physical activity.
- a. General External Cause Coding Guidelines
2) External cause code used for length of treatment - Chapter 20: External Causes of Morbidity (V00-Y99)
2) External cause code used for length of treatment
Assign the 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.
Most categories in chapter 20 have a 7th character requirement for each applicable code. Most categories in this chapter have three 7th character values: A, initial encounter, D, subsequent encounter and S, sequela. While the patient may be seen by a new or different provider over the course of treatment for an injury or condition, assignment of the 7th character for external cause should match the 7th character of the code assigned for the associated injury or condition for the encounter.
- a. General External Cause Coding Guidelines
3) Use the full range of external cause codes - Chapter 20: External Causes of Morbidity (V00-Y99)
3) Use the full range of external cause codes
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.
- a. General External Cause Coding Guidelines
4) Assign as many external cause codes as necessary - Chapter 20: External Causes of Morbidity (V00-Y99)
4) Assign as many external cause codes as necessary
Assign as many external cause codes as necessary to fully explain each cause. If only one external code can be recorded, assign the code most related to the principal diagnosis.
- a. General External Cause Coding Guidelines
5) The selection of the appropriate external cause code - Chapter 20: External Causes of Morbidity (V00-Y99)
5) The selection of the appropriate external cause code
The selection of the appropriate external cause code is guided by the Alphabetic Index of External Causes and by Inclusion and Exclusion notes in the Tabular List.
- a. General External Cause Coding Guidelines
6) External cause code can never be a principal diagnosis - Chapter 20: External Causes of Morbidity (V00-Y99)
6) External cause code can never be a principal diagnosis
An external cause code can never be a principal (first-listed) diagnosis
- a. General External Cause Coding Guidelines
7) Combination external cause codes - Chapter 20: External Causes of Morbidity (V00-Y99)
7) Combination external cause codes
Certain of the external cause codes are combination codes that identify sequential events that result in an injury, such as a fall which results in striking against an object. The injury may be due to either event or both. The combination external cause code used should correspond to the sequence of events regardless of which caused the most serious injury.
- a. General External Cause Coding Guidelines
8) No external cause code needed in certain circumstances - Chapter 20: External Causes of Morbidity (V00-Y99)
8) No external cause code needed in certain circumstances
No external cause code from Chapter 20 is needed if the external cause and intent are included in a code from another chapter (e.g. T36.0X1- Poisoning by penicillins, accidental (unintentional)).
- b. Place of Occurrence Guideline
20. Chapter 20: External Causes of Morbidity (V00-Y99)
b. Place of Occurrence Guideline
Codes from category Y92, Place of occurrence of the external cause, are secondary codes for use after other external cause codes to identify the location of the patient at the time of injury or other condition. Generally, a place of occurrence code is assigned only once, at the initial encounter for treatment. However, in the rare instance that a new injury occurs during hospitalization, an additional place of occurrence code may be assigned. No 7th characters are used for Y92.
Do not use place of occurrence code Y92.9 if the place is not stated or is not applicable.
- c. Activity Code
20. Chapter 20: External Causes of Morbidity (V00-Y99)
c. Activity Code
Assign a code from category Y93, Activity code, to describe the activity of the patient at the time the injury or other health condition occurred.
An activity code is used only once, at the initial encounter for treatment. Only one code from Y93 should be recorded on a medical record.
The activity codes are not applicable to poisonings, adverse effects, misadventures or sequela.
Do not assign Y93.9, Unspecified activity, if the activity is not stated.
A code from category Y93 is appropriate for use with external cause and intent codes if identifying the activity provides additional information about the event.
- d. Place of Occurrence, Activity, and Status Codes Used with other External Cause Code
- Chapter 20: External Causes of Morbidity (V00-Y99)
d. Place of Occurrence, Activity, and Status Codes Used with other External Cause Code
When applicable, place of occurrence, activity, and external cause status codes are sequenced after the main external cause code(s). Regardless of the number of external cause codes assigned, generally there should be only one place of occurrence code, one activity code, and one external cause status code assigned to an encounter. However, in the rare instance that a new injury occurs during hospitalization, an additional place of occurrence code may be assigned.
- e. If the Reporting Format Limits the Number of External Cause Codes
- Chapter 20: External Causes of Morbidity (V00-Y99)
e. If the Reporting Format Limits the Number of External Cause Codes
If the reporting format limits the number of external cause codes that can be used in reporting clinical data, report the code for the cause/intent most related to the principal diagnosis. If the format permits capture of additional external cause codes, the cause/intent, including medical misadventures, of the additional events should be reported rather than the codes for place, activity, or external status.
- g. Child and Adult Abuse Guideline
20. Chapter 20: External Causes of Morbidity (V00-Y99)
g. Child and Adult Abuse Guideline
Adult and child abuse, neglect and maltreatment are classified as assault. Any of the assault codes may be used to indicate the external cause of any injury resulting from the confirmed abuse.
For confirmed cases of abuse, neglect and maltreatment, when the perpetrator is known, a code from Y07, Perpetrator of maltreatment and neglect, should accompany any other assault codes.
See Section I.C.19. Adult and child abuse, neglect and other maltreatment
- h. Unknown or Undetermined Intent Guideline
20. Chapter 20: External Causes of Morbidity (V00-Y99)
h. Unknown or Undetermined Intent Guideline
If the intent (accident, self-harm, assault) of the cause of an injury or other condition is unknown or unspecified, code the intent as accidental intent. All transport accident categories assume accidental intent.
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.