Health Information Management

News: CMS offers clarification for external cause and unspecified codes in ICD-10-CM

CDI Strategies, July 18, 2013

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Use of external cause ICD-10 codes is not mandatory, CMS clarified in a recent release, unless otherwise mandated by state-based or payer-based mandates. Essentially, if the facility/provider does not report external cause codes under ICD-9-CM, they most likely will not report them under ICD-10-CM either.

However, CMS encouraged providers to voluntarily use the codes stating “they provide valuable data for injury research and evaluation of injury prevention strategies.”
The release also clarified use of sign/symptom and “unspecified” codes stating that each has “acceptable, even necessary, uses.” 
For example, in lieu of a definitive diagnosis the coder may assign codes for sign(s) and/or symptom(s). Unspecified codes will also continue to be used in ICD-10-CM and should be used when “it most accurately reflects what is known about the patient’s condition at the time of that particular encounter.”
Choosing a more specific code when documentation in the record does not support such action would be inappropriate, CMS says.
“Each health care encounter should be coded to the level of certainty known for that encounter,” according to the release. 
Editor’s Note: Curious to know what changes the four cooperating parties made to the ICD-10-CM codes for 2014? You can now find out by downloading the 2014 ICD-10-CM codes from the Centers for Disease Control and Prevention (CDC) and CMS websites.

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