E Codes – Q: Can you please review Ecodes Medical Coding for ICD-9-CM and how things will change with ICD-10?
A: Some people like to say, “Well, E codes go away in ICD-10” – well, they’re just not called E codes anymore. They don’t really go away, they’re just expanded, they’re more in-depth like the rest of ICD-10 is. E codes, yes, you could say they’ve gone away or let’s just say they’ve been updated and revised a little bit, they tweaked them.
The basics about E codes if you’re not familiar with them, they’ve got some guidelines. Now, E-codes have their own index area in your manuals, in your ICD manual. So if you need to look something up, you can do it from there. Even in the tabular, it’s pretty easy to get through them.
1) An E code may be used with any code in the range of 001-V82.9 which indicates an injury, poisoning, or adverse effect due to an external cause.
2) Assign the appropriate E code for all initial treatments of an injury, poisoning, or adverse effect of drugs. E codes are not used for subsequent visits; they’re only used in initial visits. Very important, it’s a guideline that you need to know.
3) Use a late effect E code for subsequent visits when a late effect of the initial injury or poisoning is being treated. There is no late effect E code for adverse effect of drugs.
4) Use the full range of E codes to completely describe the cause, the intent and the place of occurrence, if applicable, for all injuries, poisonings, and adverse effects of drugs. Again, there are chances where you might have to use more than one E code, that’s been known to happen.
5) Assign as many E codes as necessary to fully explain each cause. If only one E code can be recorded, assign the E code most related to the principal diagnosis.
If you get on YouTube sometimes, there are some funnies about E codes and the descriptions of them, and I can’t think of any multiple E codes just right off the top of my head; but if a person was walking across the street and got hit by a bike and then turned around and got hit by a bus. There’s actually two separate E codes for that.
6) The selection of the appropriate E code is guided by the Index to External Causes which is located after the alphabetical index to diseases and by Inclusion and Exclusion notes in the Tabular List – I would tab it in my manual, your E code Index.
7) An E code can never be a principal (first listed) diagnosis – That is kind of the very first rule that you learn about E codes. It can never be listed first. The second rule probably you learn about E codes is that it’s on the initial visit.
Review ICD-9-CM Ecodes Medical Coding – Video
What type of categories would we see that we would expect to use an E code? I made a list of those. Transport accidents – that’s talking about you’re riding your bike and you fell off your bike and you broke your arm. You are a passenger in a bus on the movie – what was that movie where the lady couldn’t slow down on the bus? And so, you got dehydrated because you had to stay in the bus for 24 hours. You couldn’t eat nor drink anything. Transport accidents – it could be a bike, it could be a vehicle, it could be an airplane; anything that transports you from one place to another place.
Poisoning and adverse effects of drugs, medicinal substances and biologicals – Poisoning because you had taken a medication that the doctor prescribed to you, but you accidentally took it in the wrong way, not the way it was listed on the label. Or, you took the medication the way it was prescribed but you had an adverse effect, you broke out in hives. This also could be poisoning because you went to go collect some healthy salad stuff out in the woods because you read a book about it or saw it on YouTube and you end up eating poison ivy, which could be a really bad thing. That would be a poisoning.
Accidental falls – they have that broken down pretty specifically, did you fall going up the steps, did you fall going down the steps? Did you fall because someone accidentally pushed you? Did you slip on a carpet? Did you slip on the ice? It just goes on and on and on. If it’s happened, there’s a code for it.
Accidents caused by fire and flames – that’s pretty diverse. Accidents caused because you were putting fire in your fireplace at your home, or let’s say you have a gas stove and you caught your sleeve in it. Or you had a can of hairspray and you went to spray somebody’s hair and they were smoking a cigarette, poof! All kinds of accidents with flame.
Accidents due to natural and environmental factors – you could slip and fall on the ice because it’s icy, or you slip and fell off a cliff, again environmental factors.
Late effect of accidents, assaults or self injury – you jumped off a building, you were attacked and mugged and you had an accident and busted your leg.
Assaults or purposely inflicted injury – there was one that always got the students that was in the Carol Buck book. I don’t know if it’s still there, but it was such a great one. A person was poisoned with snake venom in their drink and it ended up being an assault code that they put in there. How do you know it was an assault? The book explained that people don’t put snake venoms in drinks for just no reason. It was an assault! I’ll never forget that one.
Suicide or self inflicted injury – there’s all different ways, like, jumping off a building or something. But there’s different ways for suicide and/or self inflicted injury.
Now, let’s look at the differences between the external causes of morbidity and ICD-9 it’s going to be E800 through E999. But in ICD-10, the same categories are there with V00 through V98. It’s just, they’ve changed the code and they’ve expanded the code. So, I came up with an example and I didn’t have time to pull a picture of Mr. Greenjeans, but I may be dating myself a little bit for however many of you remember Mr. Greenjeans. He fell from a barn roof – that’s all the information we’ve got. We don’t know what was going on, we just know he fell from the barn roof.
So, an ICD-9 that would be E987.1 – falling from high place, undetermined whether accidentally or purposely inflicted; other man-made structures. Because they have a residence, so a barn would not be a residence, a barn is “other man-made structure.” There’s another code for, I think it’s commercial property, maybe, or something. So, you got residential, other man-made, or like a commercial building. That seems pretty diverse to me, it’s like, “Oh, wow! That captures a lot.”
But ICD-10 gives the same information, but on steroids. Now, a little hint though, you know you’ve got these GEMs and crosswalks that you can use where you can type in the ICD-9 code and get the ICD-10 code, you can type in 401.9 for essential hypertension and you’ll get I10. Or you type in I10 and you’ll get all three of the hypertension codes – malignant, benign and essential. So, you can do that. You can’t really do that with E codes because they’re so diverse in ICD-10, they don’t match, they don’t map.
Here you go. So, the same codes are pretty close to the equivalent. Here are our choices in ICD-10, we have W13, they’re all W13s. We got W13.0 – W13.9. We’ve got fall from, out of or through balcony. We’ve got out of or through bridge. We’ve got out of or through a roof. Fall through floor. Fall from, out of or through window. Fall from, out of or through other building or structure, and out of or through building, not otherwise specified.
Mind you, this even can get broke down even more and there’s other codes that maybe would even be more descriptive but I looked for a code for a fall and not saying it’s residential, not saying whether it’s… Actually, I think, don’t quote me on this, but I think these were all the ones that came up for it’s not residential, it’s not commercial; so a man-made structure. These are all the ones that could have come through a man-made structure.
We know he fell from the roof, so maybe W13.2 might be the best one. Or, he could have fallen through the window, in the front of the barn. I don’t know, we didn’t get enough information, I guess, but it said “roof.”
Interesting, isn’t it? Just really, really diverse. There’s the difference between the E codes and the V codes. Now, this is one little aspect, there’s actually even more diversity with these where you can do more codes. So, maybe we’ll reflect on that in the future and give a more detailed scenario where it’s not just the physical fall, but you can code the whole picture with ICD-10, like, what he had for lunch that day. You know, a baloney sandwich and – I’m just kidding.
Anyway, it’s a lot of fun to look at the E codes.