WC insurers expect information about the accident or disease's cause
If your surgeon is seeing patients for workers' compensation (WC) claims, you'll want to pay special attention to diagnosis coding. Specifically, coding experts advise that to have your WC claims paid the first time, you should provide information with the claim (using ICD-9 E codes) that describes how, and sometimes where, the injury the surgeon is treating occurred.
Payers require E codes: Suppose a patient suffers severe burns while working near the engine of a running bulldozer at his construction job.
Your surgeon sees the patient for debridement and skin grafts. You report 943.31 (Burn of upper limb, except wrist and hand; full-thickness skin loss [third degree NOS], forearm) and 948.00 (Burn [any degree] involving less than 10 percent of body surface; less than 10 percent or unspecified) for the burn damage, but the patient's workers' comp insurer denies the charge. Why? Because you forgot to add the appropriate E code to describe how the work-related diagnosis occurred.
You should use E codes to describe external causes of injuries or poisonings. E codes range from the common (E880.9, Fall on or from other stairs or steps) to the obscure (E847, Accidents involving cable cars not running on rails) and describe scores of accidents and injuries. In short, says Terry Fletcher, BS, CPC, CCS-P, CCS, CMSCS, CMC, a coding and reimbursement specialist in Laguna Niguel, Calif., E codes often help answer the question "How did it happen?"
In the example above, the coder should report 943.31 and 948.00, followed by E919.7 (Accidents caused by machinery; earth moving, scraping and other excavating machines) and E849.3 (Place of occurrence, industrial place and premises).
Two E Codes Double Your Specificity
Some workers' compensation insurers require you to report two E codes together - one code to describe how the patient was injured, and (as illustrated in the above example) a second to describe where the accident occurred. You'll find the "place of occurrence" codes in the E849.x series. For instance, if a patient falls off of a ladder while working on a farm, you should report E881.0 (Fall from ladder) and E849.1 (Place of occurrence, farm).
Remember: "E codes do not change your reimbursement amount because they are considered 'for informational purposes only' codes," says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for the CRN Institute, an online coding certification training center.
You should never report E codes in lieu of a diagnostic code to describe an injury, but E codes help the carrier understand how the patient was injured. Because workers' compensation insurers' payment decisions hinge on whether the patient hurt himself at work, your E codes can help you collect.
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