ICD 10 CM Place of Injury Codes

Q: ICD-10-CM - Place of Injury Codes. “I’m having trouble figuring out how to code the place of injury. Can you give me some help with understanding them?”

A: This is really great question because not every facility or every provider utilizes these codes. So, the place of injury you’re going to find that in the External Cause Codes section. Those are the old “E” codes in ICD-9 and in ICD-10 they’re now Chapter 20 for External Causes of Morbidity.

When you’re looking at these codes, the coders and the providers they’re trying to help answer questions that affect the treatment, such as how did the injury or condition happen? Was it an accident, was it a fall? Where did it happen? This is your place of injury. It’s just one of the segments of external causes. What was the patient doing when it happened? Were they riding a bike, were they skydiving, were they doing something more fun? Were they sitting in their office chair and the wheel broke and they fell off? Was it intentional or unintentional?

That section is important because if it stems from a toxin or a poison then you’re going to go to the T chapter and those codes already have this answer of intentional or unintentional. So, that one is taken care of with your diagnosis code.

When you’re looking at coding your external causes, some rules to remember, they’re in the ICD-10-CM guidelines in the section for external causes. So you’re going to look at, these codes are never sequenced as a primary or principal diagnosis nor are they reported alone, so you’re always going to have your injury code as your primary diagnosis. In most cases, these codes are only used on the initial encounter. That’s the case for the six-digit codes that they have.

The seven-digit codes have the corresponding encounter character of A, D or S. The seven-digit codes you can actually report again on your subsequent visits. Normally, you’re going to assign as many external codes as you can so you can fully explain the cause for the encounter. But there should only be one code from each for place of occurrence, activity, and one status code that’s assigned to the encounter.
You’re going to list your code sequentially to note the events causing that injury. Was it a fall? Then, you hit an object when you fell. Sometimes that happens, people fall off the ladder but then they hit a structure below the ladder, so which one caused that injury, is what they’re trying to look at so you want to sequentially code them.

Typically, your place of occurrence codes are reported after your other external causes, so you want to think of the order of how these things happened, your place of occurrences are not going to be prior to the fall or automobile accident.

So, as a coder, you may not always see these codes used. Not every insurance carrier accepts them as a valid diagnosis on your submitted claim. So, some payers and states have mandates about reporting these. Currently, there are about 15 states that do require the use of these codes. If your state is not one of those, then you can voluntarily report these codes. But I’ll get into a little bit later why you might want to report these codes.

Finally, if you have a place or an activity that’s not known or it’s not stated, then you’re not going to use. There is an unspecified code, but you’re not going to use that because it’s really not providing any more information as to how that injury occurred. So you’d be better off leaving it blank than including an unspecified Y92.9 for an unspecified place or Y93.9 for an unspecified activity. So you really would not use those those unspecified codes.

We’re going to look at an example of how one of these codes could be utilized: Patient brought to urgent care by parents. He suffered forehead and right elbow injuries while roller skating and hit a parked vehicle in the driveway. Patient was not wearing a helmet or safety gear. Treated and referred for Orthopedic follow up.
So you’d have your S09.90XA, Unspecified injury of head.

S59.901A, Unspecified injury of right elbow. I’m going to assume in this instance they don’t have an x-ray capability at the surgeon care center. Then you’re going to get into your place of occurrence codes. You have your V03.01XA is a pedestrian on roller-skates injured in collision with car, pick-up truck or van in nontraffic accident. So, you’re not in traffic, you’re not on a roadway when this happened, is your nontraffic accident. And, Y92.014 is a private driveway of your home as your place of occurrence.

A provider evaluated the patient with these injuries, asked them to follow-up with a specialist if there are still any problems. So, as the Urgent Care is where the family sought the initial treatment that facility is going to report the External Cause codes to the insurance carrier for documentation purposes.