by June Bronnert, RHIA, CCS, CCS-P
Two new E code sections go into effect October 1—E000, External Cause Status, and E001–E030, Activity. The sections will facilitate prevention strategies developed by epidemiologists and injury prevention specialists and bring ICD-9-CM E codes more in line with ICD-10-CM external cause codes.
The New E Sections and Codes
The E001–E030 section identifies engaged activities by individuals that result in a health condition or injury; the E000 section differentiates between an individual’s status as either civilian or military while performing the activity.
The activity section contains broad categories ranging from arts and handcrafts to roller coasters and other types of external motion:
- E001, Activities involving walking and running
- E002, Activities involving water and water craft
- E003, Activities involving ice and snow
- E004, Activities involving climbing, rappelling, and jumping off
- E005, Activities involving dancing and other rhythmic movement
- E006, Activities involving other sports and athletics played individually
- E007, Activities involving other sports and athletics played as a team or group
- E008, Activities involving other specified sports and athletics
- E009, Activity involving other cardiorespiratory exercise
- E010, Activity involving other muscle strengthening exercises
- E011, Activities involving computer technology and electronic devices
- E012, Activities involving arts and handcrafts
- E013, Activities involving personal hygiene and household maintenance
- E014, Activities involving person providing caregiving
- E015, Activities involving food preparation, cooking, and grilling
- E016, Activities involving property and land maintenance, building, and construction
- E017, Activities involving roller coasters and other types of external motion
- E018, Activities involving playing musical instrument
- E019, Activities involving animal care
- E029, Other activity
- E030, Unspecified activity
The external cause status section contains four new codes within one new category:
- E000.0, Civilian activity done for income or pay
- E000.1, Military activity
- E000.8, Other external cause status
- E000.9, Unspecified external cause status
Assigning E Codes
The new E codes are secondary diagnoses and are assigned with an appropriate diagnosis or injury code from other ICD-9-CM chapters. This is consistent with the guideline that E codes not be assigned as principal diagnoses.
Coding professionals should read the instructions at the beginning of each section, in addition to the excludes notes within the subcategories, for guidance. Category E003 involves ice and snow activities; however, shoveling ice and snow is classified to E016.0, Digging, shoveling, and raking. The excludes note provides this direction for proper code assignment.
Activity codes are assigned in conjunction with external cause status and place of occurrence codes. These codes are assigned when the activity resulted in or contributed to the injury or health condition. For example, if a patient falls and fractures a hip while walking at a park, five codes are assigned: one for the fractured hip, one for the fall (E888.8), one for place of occurrence (E849.4), one for the activity (E001.0), and one for the status (E000.8).
Another example illustrated in the note of this section is a heart attack while shoveling snow, which highlights the use of activity codes not only with acute injury codes but also with other health conditions. When reviewing documentation coding professionals should watch for activities the person was engaged in that result in or contribute to the health condition. The documentation, as usual, must support the proper assignment of the new codes.
The external cause status codes (E000) are assigned in conjunction with other E codes. Code E000.8, Other external cause status, is used when an off-duty military person is either injured or develops a health condition related to or contributed by an activity. If the person was on active duty during the event, then code E000.1, Military activity, would be assigned. Only one of the E000.0–E000.9 codes should be assigned for the encounter.
The codes for water transport accidents (E830–E838) added a fourth digit of .7, Occupant of military watercraft, any type. Other changes relate to the operation of war codes (E990–E999). These codes will now include injuries from war and civil insurrections that occur during peace-keeping missions in addition to the war or insurrection. Three new codes were added to E990, Injury due to war operations by fires and conflagrations, which identify a flamethrower, incendiary bullet, and indirect fire from conventional weapon.
E991 includes five new codes to identify improvised explosive devices (IEDs). The codes identify either person-born (E991.5) or vehicle-born IEDs (E991.6). Code E991.7 is used if the specific type of IED is not known. Code E991.4 identifies injuries from fragments of munitions such as artillery shells and land mines, while code E991.8 is for fragments from weapons.
Codes E992–E996 and E998 include new fourth digits that specifically identify items that have been included in these subcategories. Codes E992–E998 identify injuries due to war operations and include expansion-specific events and devices.
For example, code E992, Injury due to war operations by explosion of marine weapons, currently includes a torpedo injury. As of October 1, 2009, code E992.0 identifies the torpedo injury from war operation separately from other explosions of marine weapons. Code E997.3 identifies war operations injury by weapon of mass destruction.
Other Misadventures during Medical Care
Two new E codes for surgical misadventures join the current code E876.5, Performance of inappropriate operation. The new codes are:
- E876.6, Performance of operation (procedure) on patient not scheduled for surgery
- E876.7, Performance of correct operation (procedure) on wrong side/body part
Code E876.6 includes operations or procedures performed on the wrong patient (patients who were not scheduled for a procedure), while E876.7 is for those operations or procedures performed on the right patient but the wrong part or side of their body.
In addition to the new codes, the Hospital Inpatient Prospective Payment System proposed rule includes a new Medicare Code Editor edit titled “Wrong Surgeries” based upon three national coverage decisions regarding erroneous surgeries on Medicare patients. The edit identifies when wrong surgeries occur for Medicare patients when one of three E codes (E876.5–E876.7) are reported as either principal or secondary diagnosis. E codes are not to be reported as a principal diagnosis, and a current edit exists for this scenario that would remain the same.
Relationship to ICD-10-CM
While ICD-10-CM’s external cause codes are not the supplementary classification of external causes of injury and poisoning that E codes are in ICD-9-CM, activity codes are part of ICD-10-CM. Chapter 20, “External Causes of Morbidity,” includes codes from V01 to Y95. The ICD-10-CM Official Guidelines for Coding and Reporting note these codes are also secondary diagnoses and may be used in any healthcare setting, even if not required by third-party payers.
The external causes of morbidity codes are used to capture the cause, intent, activity, and place of occurrence of the condition or injury. As with the new ICD-9-CM codes, multiple external cause codes may be coded to fully identify all the components of the patient’s condition.
In ICD-10-CM the place of occurrence and activity codes are only reported once at the treatment of the initial encounter. Regardless of the number of other external cause codes, the activity and occurrence codes are only coded once. Activity codes are category Y93 and include a seventh character to identify the external cause status. For example, code Y93.0151 is individual sport activity, golf, nonwork-related activity.
Centers for Medicare and Medicaid Services (CMS). “Acute Inpatient PPS: FY 2010 Proposed Rule Home Page: CMS-1406 Proposed Rule.” Available online at www.cms.hhs.gov/AcuteInpatientPPS/FY2010RULE/list.asp.
CMS. “ICD-9 Provider & Diagnostic Codes: New, Deleted, and Revised ICD-9-CM Codes—Summary Tables.” Available online at www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp.
CMS. “Medicare Coverage Database: Decision Memo for Surgery on the Wrong Body Part (CAG-00401N).” January 15, 2009. Available online at https://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=223.
CMS. “Medicare Coverage Database: Decision Memo for Surgery on the Wrong Body Part (CAG-00402N).” January 15, 2009. Available online at https://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=222.
CMS. “Medicare Coverage Database: Decision Memo for Surgery on the Wrong Body Part (CAG-00403N).” January 15, 2009. Available online at https://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=221.
June Bronnert (firstname.lastname@example.org) is a director of professional practice at AHIMA.
"Assigning E Codes: Two New Sections Go into Effect October 1"
Journal of AHIMA