The document provides guidelines for coding external causes of morbidity using ICD-10-CM codes ranging from V00-Y99. It states that external cause codes are never sequenced as the principal diagnosis, are intended for injury research and prevention, and reporting is not nationally mandatory. It provides priorities for sequencing multiple external cause codes and guidelines for coding child abuse, terrorism, unknown intent, sequelae, place of occurrence, activity codes and external cause status.

1. Chapter 20: External
Causes of Morbidity
(V00 – Y99)

2. General Requirements
 Never be sequenced as the first-listed or principal diagnosis
 Intended to provide data for injury research and evaluation of injury prevention strategies.
 No National requirement for mandatory ICD-10-CM external cause code reporting.

3. General External Cause Coding Guidelines
 Used with any code in the range of A00.0 – T88.9 & Z00-Z9920.
 External cause code used for length of treatment
 Use the full range of external cause codes
 Assign as many external cause codes as necessary
 The selection of the appropriate external cause code
 External cause code can never be a principal diagnosis
 Combination external cause codes –EG; W18.09
 No external cause code needed in certain circumstances .EG; T36.0X1-
poisoning by penicillins, accidental (unintentional)

4. Place of Occurrence Guidelines
 Category Y92,
 Place of occurrence of the external cause – secondary external cause
codes
 .Only assigned once, at the initial encounter for treatment.
 No 7th character If place is not stated or not applicable, do not code

5. Activity Code
 Y93, Activity Code,
 Describes the activity at the time of the injury
 Only assigned once, at the initial encounter for treatment.
 Not applicable to poisonings, adverse effects, misadventures or sequela.
 If activity is not stated or not applicable, do not code Appropriate for use with external cause and
intent codes if provides additional information

6. Sequncing
 External cause code(V,W,X,Y) Accidental, unintentional(assault),
intentional(suicide),undetermined intent
 Place of occurance ( Y92)
 Activity (Y93)
 Status (Y99)

7. Multiple External Cause Coding
Guidelines
 More then one external cause code is required to fully describe the external
cause of an illness or injury
 Priority Sequencing:
 Child and adult abuse
 Terrorism
 Cataclysmic events
 Transport accidents
 Activity and external cause status codes assigned after all causal (intent)
codes

8. Child and Adult Abuse
 Abuse, neglect and maltreatment are all classified as assault
 Only code if confirmed abuse
 If perpetrator is known, also code from Y07, Perpetrator of maltreatment and neglect.

9. Sequelae (late Effects)
 Sequelae external cause codes
 Reported with 7th digit “S” and should be used with any report of a late
effect resulting from a previous injury.
 Sequela external cause code with a related current injury
 Never used with a related current nature of injury code
 Use of sequela external cause codes for subsequent visits
 Used when a late effect of the initial injury is being treated, not for
subsequent visits for follow-up care of the injury when no late effect of
the injury has been documented

10. Terrorism Guidelines
 Cause of injury identified by the Federal Government (FBI) as
terrorismCode from Y38,
 Terrorism should be used as the firsts listed external cause code
 More than one Y38 code may be assigned if the injury is the result of
more than one mechanism of terrorism
 Cause of an injury is suspected to be the result of terrorism
 Do not code from Y38, suspected is coded as assault
 Code Y38.9, Terrorism, secondary effects Conditions occurring
subsequent to the terrorist event
 It is acceptable to code from Y38.9 and another Y38 category if there is
an injury due to the initial terrorist event and an injury that is a
subsequent result of the terrorist event

11. Unknown or Undetermined Intent
 If the intent of the cause of injury is unknown or unspecified, code as
accidental intent
 All transports are assumed accidental intent.
 Use of undetermined intent
 External cause codes for events of undetermined intent are ONLY for
use if the documentation in the record specifies that the intent cannot
be determined

12. External Cause Status Code Category Y99
 Should be used whenever any other external cause code is assigned for
an encounter, except listed exceptions.
 Exceptions: poisonings, adverse effects, misadventures or late effects.
 Codes are used to indicate the work status at the time of the event . Ex:
military activity, work, student, volunteer, etc.
 Do not use if no other external cause codes used
 Only used at the initial encounter If status is not stated or not
applicable, do not code

13. THANK YOU