External Causes of Morbidity (V00-Y99)

These codes can often be missed/left off when coding medical records.  External cause of morbidity codes provide additional information such as how the injury occurred, the intent, the place it occurred and the status of the patient at the time of the injury. There is no national requirement for mandatory reporting of these codes.  If this information is available it should be reported, unless facility policy dictates otherwise.

Remember “IPAS” when coding from Chapter 20:

I-injury specific external code such as external cause code for fall from one level to another
P-place of occurrence external cause code if stated
A-activity the patient was doing when the injury occurred
S-status of the patient such as civilian, military, etc.

Excerpts from ICD-10-CM Official Guidelines for Coding and Reporting (Pages 74-85)

• An external cause code can be used with any code (A00.0-T88.9, Z00-Z99) but are mostly used for injuries
• Code the external cause codes for each visit as long as the injury or condition is being treated (be sure and select the appropriate 7th character for initial, subsequent and sequela encounters)
• Use the full range of external cause codes when documented to describe the cause, intent, the place of occurrence, and the activity of the patient at the time of the event (if applicable)
• Coders may assign as many external cause codes as necessary to fully report the injury (or other disease)
• This particular set of codes can NEVER be the principal diagnosis or the primary diagnosis
• If the external cause and intent are included in a code from another chapter, no external cause code from Chapter 20 is necessary (example would be OD of drug due to accidental ingestion)
• Place of occurrence codes should be reported AFTER other external cause codes
• Place of occurrence codes do not have 7th characters and are typically only reported on the initial encounter for treatment
• Do not code unspecified place of occurrence if the place is not specified unless facility policy dictates otherwise
• Activity codes are used only once and are not applicable to poisonings, adverse effects, misadventures, or sequela
• Do not code unspecified activity if the activity is not specified unless facility policy dictates otherwise

Be sure to review the document in its’ entirety (ICD-10-CM Official Guidelines for Coding and Reporting Pages 75-81) for examples, sequencing advice, how to report multiple external cause codes, child and adult abuse, sequelae of external causes (late effects), and other detailed information regarding Chapter 20.

Authored by Kim Boy, RHIT, CDIP, CCS, CCS-P

References
ICD-10-CM Official Guidelines for Coding and Reporting

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The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.