Cracking the Code

Coding External Cause Codes

CMS explains external cause codes as codes that capture how the injury or health condition happened, the intent (whether unintentional or accidental, or intentional), the place where the event occurred, the activity of the patient at the time of the event, or the person’s status (such as military or civilian).

External cause codes should never be sequenced as the first listed or principal diagnosis. These codes are encouraged to be voluntarily reported as they provide valuable data for injury research and evaluation of injury prevention strategies.  CMS guidelines further state to assign as many external codes as necessary to fully explain each cause.

Most of the main terms that are listed alphabetically in the ICD-10-CM External Cause of Injuries indicate the type of accident (fall or collision) or intentional violent assault (such as a stabbing or a shooting). The term listed under the main term is the specific incident associated with that main term.

Q: True or False: External cause codes are never sequenced first.
A: True: According to the ICD-10-CM guideline I.C.20.a.6, an external cause code can never be a principal/first-listed diagnosis
Reference: FY 2023 ICD-10-CM Coding Guidelines, CMS Website
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