Health Information Management

Tip: Determine how to report cause of injury codes in ICD-10-CM

APCs Insider, October 30, 2015

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When a body part meets with an external object and the result is an injury, you must explain what that external object or force was. Sequence this external cause code after the code or codes for the injury itself.
The cause may be anything from being stepped on by a cow (W55.29X-) to falling from scaffolding (W12.XXX-) to the forced landing of a hot air balloon injuring the occupant (V96.02X-).
Domestic violence, child abuse, and elder abuse are considered assault and may be the cause of a physical injury (code category Y07).
You need to determine from the documentation what caused the fracture, dislocation, sprain, or strain, and report it with the appropriate code or codes.
With ICD-10-CM, the external cause codes will continue to be reported throughout treatment, not solely with the first encounter.
This tip is adapted from “Reporting ICD-10-CM external causes is no joke" in the October issue of Briefings on APCs.

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