Practice Management Articles

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Clinical Distribution of Sample Medications in the Practice Setting Health Care Quality Standards	Coding ICD-10 Where is it? When is it?  Close "E"ncounters of the Third Kind Incorrect use of Modifer 25 & 59 The Facts About Consultations"What You Need To Know"  Understanding Physician Supervision Levels Inpatient vs. Critical Care Consult Inpatient vs. Critical Care Consult
Collections Timely Tips for Collections  Finance Charges & Sending a Patient to Collection Making Collection Calls the Right Way Letter to the Editor Patient Collections: Retaining Patients, Even When They Owe	Legal & Compliance Reimbursement. Compliance. Overpayments. Auditing The Watchful Eye of the Government – Understanding The Office of Inspector General Work plan Are You "STILL" in Compliance With the "Hazard Communication Standard"? What You Don’t Know About OSHA Can Hurt You New Red Flag Rules to Target Identity Theft New Standards, Versions and Code Set for Electronic Transactions Begin January 2012. Will You Be Ready? Do The New Red Flag Rules Apply to Your Practice? What you need to know about this fast-approaching deadline
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Close "E"ncounters of the Third Kind
Ione Broussard, CMC, CMIS, CMOM

Welcome to the land of the unknown…the land where few men have ever traveled…that is, until they came to a PMI coding class. Yes folks, I am talking about the infamous E codes. They can be found in the index in the back of your ICD-9, Vol. II, Section 3, that describes external causes of injury and poisoning. Now let's take a few minutes to get up close and personal with these foreign bodies.

Correct coding requires you to report added information so that you can code an encounter to the highest level of specificity as possible. These codes also support the work-related nature of certain injuries to differentiate worker's compensation care from non-worker's comp care. E codes should be used to describe the accident, circumstance, event, or specific agent which caused the injury or other adverse effect. That is, it will paint the full picture of what made your patient arrive at your doorstep. The Category I Code (CPT code) will describe what you did for your patient.

E codes do not change your payment amount because they are used for stats for informational purposes. These codes will never, ever, as long as you're alive, be a primary diagnosis! It says so in the directions in the index (make sure you turn to this index in your ICD-9 book and read through it before you embark on these codes). Ok, I know that few of you will read the entire thing, but I would like you to take note of the last sentence in the first paragraph: "…it is intended that the E code shall be used in addition to a code from the main body of the classification, Chapters 1 to 17." See I told you so.

Now, I don't know about you but I find E codes fascinating. It's amazing to me how many ways can a person injure themselves. They can have injury caused by: animal (ridden or not), bending (that's it, no aerobics for me – I can hurt myself), bite (human or animal, if you ask me they are sometimes one in the same), earthquake, fire, hurricane, rough landing (like my last job), sound waves (and consumers buy those sound machines to make them sleep - now we know), twisting (the twist is an outdated dance anyway, but now I know why I hurt the next day), in or on and don't forget stated as (that means I've got to rely on you-know-who for this bit of information to be documented in the patient's chart).

When you get your new ICD-9 book, you should always go immediately to the "Summary of Code Changes" to see what's new with all the codes. I have always taken special pleasure in reviewing the E codes. Now I have disappointed in the last two years that there haven't been any new E codes (I know – I need a life) but hey, here's to hoping and praying. Stay tuned for your new ICD-9 books for 2008 as early as August of this year. And don't forget that new codes should be implemented in October.