against object, initial encounter
If your physician includes the external cause in his documentation,
start by recording the initial injury code and then assigning the
appropriate action code from the V00-Y84 categories in Chapter 20.
Note that these codes often have a 7
th
character requirement. There
can be 3 options for this 7
th
character: A for initial encounter, D for
subsequent encounter and S for sequela (complications or conditions
that arise as a direct result of the injury, such as pain or scar forma-
tion).
While a few different providers may see the patient over the course
of treatment for an injury, the assignment of the 7
th
character for the
external cause should match the 7
th
character of the code assigned
for the associated injury or condition. In the example above, the sec-
ondary action code has an A in the 7
th
spot, matching the A in princi-
pal injury code.
More options to consider
Keep in mind that you may report multiple external cause codes.
After you assign the initial action code, you can then add place of
occurrence codes, activity codes and external cause status codes that
further describe the injury. These should only be used if they are
described in the physician's notes and when applicable. They are list-
ed on the claim after the initial external cause action code. Here's a
quick rundown:
• Place of occurrence codes are found in category Y92 of the manu-
al. These identify the location of the patient at the time of injury.
• Activity codes are found in category Y93. They are used to
describe the patient's activity at the time of the injury.
• External cause status codes are found in category Y99. A code
from category Y99 should be assigned with another external cause
code except for codes signifying poisoning, adverse effect, misadven-
Coding & Billing
CB
4 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A Y 2 0 1 6
