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  1. GUIDELINES FOR CODING EXTERNAL CAUSES OF INJURIES, POISONINGS AND ADVERSE EFFECTS OF DRUGS (E Codes)
  2. Introduction: These guidelines are provided for those who are currently collecting E codes in order that there will be standardization in the process. If your institution plans to begin collecting E codes, these guidelines are to be applied. The use of E codes are supplemental to the application of basic ICD-9-CM codes. E codes are never to be recorded as principal diagnosis (first listed in the outpatient setting) and are not required for reporting to the Health Care Financing Administration.

    Injuries are a major cause of mortality, morbidity and disability. In the United States, the care of patients who suffer intentional and unintentional injuries and poisonings contributes significantly to the increase in medical care costs. External causes of injury and poisoning codes (E codes) are intended to provide data for injury research and evaluation of injury prevention strategies. E codes capture how the injury or poisoning happened (cause), the intent (unintentional or accidental; or intentional, such as suicide or assault ), and the place where the event occurred. Some major categories of E codes include:

    transport accidents

    poisoning and adverse effects of drugs, medicinal substances and biologicals

    accidental falls

    accidents caused by fire and flames

    accidents due to natural and environmental factors

    late effects of accidents, assaults or self injury

    assaults or purposely inflicted injury

    suicide or self inflicted injury

    These guidelines apply for the coding and collection of E code from records in hospitals, outpatient clinics, emergency departments, other ambulatory care settings and physician offices except when other specific guidelines apply. (See Reporting Diagnostic Guidelines for Hospital-based Outpatient Services/Reporting Requirements for Physician Billing.)

    1. GENERAL E CODE CODING GUIDELINES
      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.
      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 effects 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.
      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.
      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.
      7. An E code can never be a principal (first listed) diagnosis.
    2. PLACE OF OCCURRENCE GUIDELINE
    3. Use an additional code from category E849 to indicate the Place of Occurrence for injuries and poisonings. The Place of Occurrence describes the place where the event occurred and not the patient's activity at the time of the event.

      Do not use E849.9 if the place of occurrence is not stated.

    4. POISONINGS AND ADVERSE EFFECTS OF DRUGS, MEDICINAL AND BIOLOGICAL SUBSTANCES GUIDELINES
      1. Do not code directly from the Table of Drugs and Chemicals. Always refer back to the Tabular List.
      2. Use as many codes as necessary to describe completely all drugs, medicinal or biological substances.
      3. If the same E code would describe the causative agent for more than one adverse reaction, assign the code only once.
      4. If two or more drugs, medicinal or biological substances are reported, code each individually unless the combination code is listed in the Table of Drugs and Chemicals. In that case, assign the E code for the combination.
      5. When a reaction results from the interaction of a drug(s) and alcohol, use poisoning codes and E codes for both.
      6. If the reporting format limits the number of E codes that can be used in reporting clinical data, code the one most related to the principal diagnosis. Include at least one from each category (cause, intent, place) if possible. If there are different fourth digit codes in the same three digit category, use the code for "Other specified" of that category. If there is no "Other specified" code in that category, use the appropriate "Unspecified" code inthat category. If the codes are in different three digit categories, assign the appropriate E code for other multiple drugs and medicinal substances.
    5. MULTIPLE CAUSE E CODE CODING GUIDELINES
    6. If two or more events cause separate injuries, an E code should be assigned for each cause. The first listed E code will be selected in the following order:

      E codes for child and adult abuse take priority over all other E codes- see Child and Adult abuse guidelines

      E codes for cataclysmic events take priority over all other e codes except child and adult abuse

      E codes for transport accidents take priority over all other e codes except cataclysmic events and child and adult abuse

      The first list E code should correspond to the cause of the most serious diagnosis due to an assault, accident, or self-harm, following the order of hierarchy listed above.

    7. CHILD AND ADULT ABUSE GUIDELINE
      1. When the cause of an injury or neglect is intentional child or adult abuse, the first listed e code should be assigned from categories E960-E968, Homicide and injury purposely inflicted by other persons, (except category E967). An E code from category E967, Child and adult battering and other maltreatment, should be added as an additional code to identify the perpetrator, if known.
      2. In cases of neglect when the intent is determined to be accidental E code E904.0, Abandonment or neglect of infant and helpless person, should be the first listed E code.
    8. UNKNOWN OR SUSPECTED INTENT GUIDELINE
      1. If the intent (accident, self-harm, assault) of the cause of an injury or poisoning is unknown or unspecified, code the intent as undetermined E980-E989.
      2. If the intent (accident, self-harm, assault) of the cause of an injury or poisoning is questionable, probable or suspected, code the intent as undetermined E980-E989.
    9. UNDETERMINED CAUSE
    10. When the intent of an injury or poisoning is known, but the cause is unknown, use codes: E928.9, Unspecified accident, E958.9, Suicide and self-inflicted injury by unspecified means, and E968.9, Assault by unspecified means.

      These E codes should rarely be used as the documentation in the medical record, in both the inpatient and outpatient settings, should normally provide sufficient detail to determine the cause of the injury.

    11. LATE EFFECTS OF EXTERNAL CAUSE GUIDELINES
      1. Late effect E codes exist for injuries and poisonings but not for adverse effects of drugs, misadventures and surgical complications.
      2. A late effect E code (E929, E959, E969, E977, E989, or E999) should be used with any report of a late effect or sequela resulting from a previous injury or poisoning (905-909).
      3. A late effect E code should never be used with a related current nature of injury code.
    12. MISADVENTURES AND COMPLICATIONS OF CARE GUIDELINES

Assign a code in the range of E870-E876 if misadventures are stated by the physician.

Assign a code in the range of E878-E879 if the physician attributes an abnormal reaction or later complication to a surgical or medical procedure,

but does not mention misadventure at the time of the procedure as the cause of the reaction.

 
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ICD-10 codes, terms, and text World Health Organization, 1992-94