External
cause codes are
never
sequenced as
the first-listed
or principal
diagnosis —
instead, these
are listed in
addition to the
main injury
code to provide
more informa-
tion about what
caused the con-
dition. If you're
having trouble
coding external
causes, or need to provide enhanced claims for your payers or state
regulators, here is your primer on how to use them.
The basics
You can add an external cause code to any diagnosis in the range of
A00.0 through T88.9 in ICD-10, but they are primarily applicable to
acute injuries from Chapter 19 (S00 to T88). Let's walk through an
example: If a patient arrives with an acute right anterior cruciate liga-
ment sprain, caused by a slip and fall, the injury and external cause
would be reported with the following codes:
• S83.511A Sprain of anterior cruciate ligament of right knee, initial encounter
• W01.0XXA Fall on same level from slipping, tripping and stumbling without subsequent striking
M A Y 2 0 1 6 • O U T PA T I E N TS U R G E R Y. N E T • 4 1
Not all injuries will be as well described as this acute right anterior
cruciate ligament sprain. However, correct external cause coding means
capturing as much information about the initial injury as is documented.
CPT 29888-RT Arthroscopically aided anterior cruciate ligament
repair/augmentation or reconstruction
S83.511A Sprain of anterior cruciate ligament of right knee,
initial encounter
W01.111A Fall on same level from slipping, tripping and
stumbling with subsequent striking against
power tool or machine, initial encounter
Y92.61 Building [any] under construction as the place
of occurrence of the external cause
Y93.H3 Activity, building and construction
Y99.0 Civilian activity done for income or pay
External Cause Codes
For an ACL Repair
