E-Code sequencing
Transport/vehicle accidents
Poisonings and adverse effects of drugs
Accidental falls
Accidents caused by fire
Accidents due to natural and environmental factors
Late effects of accidents, assaults
Assaults or purposely inflicted injury
Suicide or self-inflicted injury
Surgical and medical procedures as cause of abnormal reaction or later complication
E-CODE CODING GUIDELINES:
1. E codes may be used with any ICD-9-CM diagnosis code in the range 001-V82.9.
2. Assign an E code only for the initial treatment of an injury, poisoning or adverse effect of a drug. E codes also may be assigned while the acute fracture codes are still applicable.
3. Assign an E code indicating late effect for any subsequent encounter when that late effect is being treated.
4. If only one E code can be recorded, assign the one related to the principal or first-listed diagnosis.
5. Assign an additional code from category E849 to identify the place of occurrence, if known.
If two or more events cause separate injuries, an E code should be assigned for each cause. If the injury is due to two or more external causes, the code for the direct cause is listed first.
Example: A patient suffered a sprained ankle after being pushed off a curb during a fight. A code for the sprain is assigned, as well as codes E880.1 (fall on or from sidewalk curb) and E960.0 (unarmed fight or brawl).
Sequencing Hierarchy: The first listed E code should correspond to the most serious diagnosis that is due to an external cause. The following sequencing hierarchy should be followed:
E codes for child and adult abuse take priority over all other E codes.
E codes for terrorism events take priority over all other E codes except those for abuse.
E codes for cataclysmic events take priority over all other E codes except those for abuse and terrorism.
E codes for transport accidents take precedence over all other E codes except those for abuse, terrorism and cataclysmic events. Coding Intent: Coding guidelines indicate
that if the intent of the cause of an injury or poisoning is unknown, unspecified, questionable, probable or suspected, code the intent as undetermined, E980-E989.
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. As stated in the coding guidelines, these E codes should rarely be used because the documentation in the medical record, in both the inpatient and outpatient as well as other settings, normally should provide sufficient detail to determine the cause of the injury.
Transportation Accident: When a transportation accident involves more than one type of vehicle, the following order of precedence should be followed:
Aircraft or spacecraft
Watercraft
Motor vehicle
Railway
Other road vehicle Terrorism E Codes: When the cause of an injury is identified by the FBI as terrorism, the first-listed E code should be a code from category E979, Terrorism. The definition of terrorism used by the FBI is found in the tabular listing as an instructional note for category E979. The terrorism E code is the only E code that should be assigned. Additional E codes from the assault categories should not be coded. E codes from category E979 should only be used when terrorism has been confirmed. Do not use a code from category E979 when terrorism is suspected. Use, instead, the appropriate E code(s) based upon the circumstances documented in the medical record.
Poisonings and Adverse Effects of Drugs, Medicinal and Biological Substances: Conditions documented as due to a drug, medicinal or biological substance are classified as either poisonings or adverse effects. The condition is coded as an adverse effect if the substance is taken or administered as prescribed. When a substance is not taken or administered as prescribed, it is coded as a poisoning.
Coders should use as many codes as necessary to describe all agents responsible for the adverse effect or poisoning. If the same E code describes the causative agent for more than one adverse reaction, assign the code only once. If two or more agents are reported, code each individually unless the combination code is listed. If the reporting format limits the number of E codes that can be reported, assign the code most related to the principal or first-listed diagnosis. When a reaction results from the interaction of a drug and alcohol, use poisoning codes and E codes for both.
Codes from the E930-E949 series must be used to identify the substance responsible for an adverse effect of a drug or substances, correctly prescribed and properly administered. The adverse effect, such as vomiting or dehydration, is coded first and is followed by the appropriate code from E930-E949.
Example: A patient is seen for nausea and lightheadedness after taking over-the-counter antihistamines for hay fever. Assign codes 787.02 (nausea) and 780.4 (lightheaded-ness) followed by code E933.0 (antialler-gic and antiemetic drugs causing adverse effect during therapeutic use) and code 477.9 for hay fever.
Place of Occurrence: Use an additional E code from category E849 to indicate the place of occurrence for injuries and poisonings. The place of occurrence describes where the event occurred. Do not use E849.9 if the place of occurrence is not stated.
Example: A patient is seen for a wrist sprain after falling off a chair at home. A code for the wrist sprain is assigned along with codes E884.2 (fall from chair) and E849.0 (place of occurrence, home).
Poisonings and adverse effects of drugs
Accidental falls
Accidents caused by fire
Accidents due to natural and environmental factors
Late effects of accidents, assaults
Assaults or purposely inflicted injury
Suicide or self-inflicted injury
Surgical and medical procedures as cause of abnormal reaction or later complication
E-CODE CODING GUIDELINES:
2. Assign an E code only for the initial treatment of an injury, poisoning or adverse effect of a drug. E codes also may be assigned while the acute fracture codes are still applicable.
3. Assign an E code indicating late effect for any subsequent encounter when that late effect is being treated.
4. If only one E code can be recorded, assign the one related to the principal or first-listed diagnosis.
5. Assign an additional code from category E849 to identify the place of occurrence, if known.
Example: A patient suffered a sprained ankle after being pushed off a curb during a fight. A code for the sprain is assigned, as well as codes E880.1 (fall on or from sidewalk curb) and E960.0 (unarmed fight or brawl).
Sequencing Hierarchy: The first listed E code should correspond to the most serious diagnosis that is due to an external cause. The following sequencing hierarchy should be followed:
E codes for child and adult abuse take priority over all other E codes.
E codes for terrorism events take priority over all other E codes except those for abuse.
E codes for cataclysmic events take priority over all other E codes except those for abuse and terrorism.
E codes for transport accidents take precedence over all other E codes except those for abuse, terrorism and cataclysmic events. Coding Intent: Coding guidelines indicate
When the intent of an injury or poisoning is known, but the cause is unknown, use codes E928.9, Unspecified accident; E958.9,
Transportation Accident: When a transportation accident involves more than one type of vehicle, the following order of precedence should be followed:
Aircraft or spacecraft
Watercraft
Motor vehicle
Railway
Poisonings and Adverse Effects of Drugs, Medicinal and Biological Substances: Conditions documented as due to a drug, medicinal or biological substance are classified as either poisonings or adverse effects. The condition is coded as an adverse effect if the substance is taken or administered as prescribed. When a substance is not taken or administered as prescribed, it is coded as a poisoning.
Coders should use as many codes as necessary to describe all agents responsible for the adverse effect or poisoning. If the same E code describes the causative agent for more than one adverse reaction, assign the code only once. If two or more agents are reported, code each individually unless the combination code is listed. If the reporting format limits the number of E codes that can be reported, assign the code most related to the principal or first-listed diagnosis. When a reaction results from the interaction of a drug and alcohol, use poisoning codes and E codes for both.
Codes from the E930-E949 series must be used to identify the substance responsible for an adverse effect of a drug or substances, correctly prescribed and properly administered. The adverse effect, such as vomiting or dehydration, is coded first and is followed by the appropriate code from E930-E949.
Example: A patient is seen for nausea and lightheadedness after taking over-the-counter antihistamines for hay fever. Assign codes 787.02 (nausea) and 780.4 (lightheaded-ness) followed by code E933.0 (antialler-gic and antiemetic drugs causing adverse effect during therapeutic use) and code 477.9 for hay fever.
Place of Occurrence: Use an additional E code from category E849 to indicate the place of occurrence for injuries and poisonings. The place of occurrence describes where the event occurred. Do not use E849.9 if the place of occurrence is not stated.
Example: A patient is seen for a wrist sprain after falling off a chair at home. A code for the wrist sprain is assigned along with codes E884.2 (fall from chair) and E849.0 (place of occurrence, home).