AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2013 Issue 2
Clarification on the Use of External Cause and Unspecified Codes in ICD-10-CM
The following statement was approved and posted by the four Cooperating Parties in May 2013 and is now reproduced in its entirety. External Cause Codes Just as with ICD-9-CM, there is no national requirement for mandatory ICD-10-CM external cause code reporting. Unless a provider is subject to a state-based external cause code reporting mandate or these codes are required by a particular payer, reporting of ICD-10-CM codes in Chapter 20, External Causes of Morbidity, is not required. If a provider has not been reporting ICD-9-CM external cause codes, the provider will not be required to report ICD-10-CM...
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Article Overview
This article explains a May 2013 statement from the Cooperating Parties on when ICD-10-CM external cause codes are or are not required, and how sign, symptom, and unspecified codes should be used when documentation does not support a more specific diagnosis. It is relevant to coders, compliance staff, and providers who need to understand general ICD-10-CM reporting expectations and the role of documentation certainty in code selection.
Why This Topic Matters
It helps coding professionals understand when broader ICD-10-CM reporting guidance applies and how to align code reporting with what is actually documented in the medical record.
Article Sections
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External Cause Codes
General guidance on reporting external cause codes in ICD-10-CM, including when reporting may be expected based on outside requirements and when voluntary reporting is encouraged.
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Sign/Symptom/Unspecified Codes
General guidance on the appropriate use of sign, symptom, and unspecified codes when a more definitive diagnosis is not established or cannot be supported by the available documentation.
What You Will Learn
- When external cause code reporting may be required versus optional
- How sign, symptom, and unspecified codes fit into ICD-10-CM documentation-based coding
- Why encounter-level certainty matters in code selection
- How official guidance addresses specificity when documentation is limited
Who Should Read This
- Medical coders
- Coding auditors
- Compliance professionals
- Physicians and other providers
- Clinical documentation improvement staff
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