This document discusses ICD-10-CM coding for terrorism-related injuries and deaths. It provides definitions for terrorism-related injuries as designated by the FBI. Codes in category Y38 are used to identify injuries resulting from terrorism and are classified based on the type of attack and injured person. External cause codes in Chapter 20 capture how the injury occurred, intent, place, patient activity, and patient status. While not mandatory, reporting these codes provides beneficial data for research. Guidelines specify terrorism codes should not be primary diagnoses and additional codes indicate nature of injury and place of occurrence. Examples of specific terrorism codes are also given.

1. Coding For Terrorism
In ICD-10-CM
By Debbie Jones, HCS-D, CCA, CPC-A

2. Purpose of reporting terrorism codes
▪ To capture the terrorist element responsible for a person’s injury or death.
▪ Without these codes, it is impossible to properly track whether a person’s death
or injury is related to terrorism.

3. Definition of terrorism-related injury
▪ As designated by the FBI and stated at the beginning of ICD-10-CM Terrorism
Category Y38:
“Terrorism codes are for use to identify injuries resulting from the
unlawful use of force or violence against persons or property to intimidate
or coerce a Government, the civilian population, or any segment thereof,
in furtherance of political or social objective.”

4. Y38 terrorism codes are classified by:
▪ Type of terrorist attack and then by the type of person injured, such as public
safety official, civilian, or terrorist.
▪ A 7th character is also required to indicate whether the episode of care is initial
(A), subsequent (D), or sequela (S).
▪ Providers and healthcare facilities are able to report the patient’s full incident
related to an injury related to terrorism.

5. Chapter 20 – External Causes of Morbidity (V00-Y99)
This chapter:
▪ Includes the Y38 Terrorism codes.
▪ Captures how the injury or health
condition happened; the intent, such
as suicide or assault; the place
where it occurred; the patient’s
activity at the time; and the person’s
status, such as civilian or military.
Requirements:
▪ No national requirement for mandatory
external cause code reporting.
▪ If provider is not required by the state
to report external causes codes, or a
particular payer does not require it, it
is not necessary to assign a code.
▪ Providers are encouraged, however, to
voluntarily report these codes since
they provide beneficial data for injury
research and interpretation of injury-
prevention strategies.

6. ICD-10-CM chapter-specific coding guidelines
that apply to terrorism-related incidents
▪ Y38 Terrorism codes should not be sequenced as first-listed or principal
diagnosis. Rather, they should be coded secondary to a code that indicates the
nature of the condition.
▪ Terrorism-related incidences would typically be classified to Chapter 19, Injury,
Poisoning, and Certain Other Consequences of External Causes (S00-T88).
▪ One or more codes from Y38 may be assigned if the injury is the result of more
than one means of terrorism.

7. ICD-10-CM chapter-specific coding guidelines,
cont’d.
▪ Assign additional code for place of occurrence (Y92.-) This would be a secondary
code assigned after another external cause code to indicate the location of the
patient at time of injury.
▪ When the cause of injury is suspected to be due to terrorism, category Y38
should not be assigned, but rather, it should be considered an assault.
▪ Y38.9, Terrorism, secondary effects, should be assigned for conditions occurring
subsequent to the terrorist act. It should not be used for conditions directly related
to the initial terrorist event.
▪ Y38.9 may be assigned with another code from Y38 if there is an injury due to the
initial terrorist event and a subsequent injury as a result of the initial terrorist act.

8. Terrorism codes
▪ Include the following, but are not limited to these.
▪ 7th character is required to indicate episode of care.
Code Description
Y38.1x1 Terrorism involving destruction of aircraft, public safety official injured
Y38.3x3 Terrorism involving fires, conflagration and hot substances, terrorist injured
Y38.4x2 Terrorism involving firearms, civilian injured
Y38.6x3 Terrorism involving biological weapons, terrorist injured
Y38.811 Terrorism involving suicide bomber, public safety official injured
Y38.9x2 Terrorism, secondary effects, civilian injured
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