More discussion of codes that use placeholder xxxA (or xxx with another 7^th character).

When a patient presents for an injury after a fall, practitioners may be tempted to search for the word “fall” and select the first diagnosis that they find. Perhaps, they find the code W06.xxxA “fall from a bed” or even W19.xxxA “unspecified fall”. They select the code, close the encounter, and move on to the next patient.

Experienced coders and billers know this is unlikely to get the claim paid.  If fall is the only diagnosis code or the first diagnosis code on the claim form, the claim is likely to be denied or the payer will ask for additional information.

The primary diagnosis should be the injury code. Sprained ankle, contusion, laceration, fracture. In the second position, sequence the external cause code. According to ICD-10-CM these are supplemental and not required for submission. But again, not including an external cause code is likely to bring a denial or request for additional information and will slow payment.

The injury code should be sequenced FIRST, and the external cause sequenced SECOND. If the patient has multiple injuries, code the  most serious in the first position.

According to the Official Guidelines the correct method for coding these is to start with the Index to Diseases and injury. Chapter 19, “Injury, Poisoning, and Certain Other Consequences of External Causes (S00—T88)” is where injury diagnosis codes are found. Most categories in the chapter will require a seventh character extender. If the category or subcategory code that describes the injury is less than six characters, a placeholder code x, or xx or xxx will be needed so that the seventh character is in the seventh position. Although fracture codes have other options for seventh characters, most injuries use one of three 7^th characters.

A: initial encounter

D: subsequent encounter

S: sequela

Chapter 20 External Causes of Morbidity (V00—Y99)

The first sentence in the guidelines for Chapter 20 states “The external causes of morbidity codes should never be sequenced as the first-listed or principal diagnosis.” These codes provide information about how the injury or health condition happened, the intent, the place where the event occurred, and the patient activity when the injury occurred. In an inpatient setting, multiple external cause codes are likely to be used. In a physician practice, it is critical to report the injury and at least one external cause code.