Outpatient Facility Coding Alert - 2012 Issue 18
Denial Management: Not So Fast: Put the Brakes on E Codes as Primary Dx
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Article Overview
This article covers a CMS denial-management update related to ICD-9-CM external cause codes on paper claims, along with a broader refresher on how E codes fit into injury-related diagnosis reporting. It is aimed at coders, billers, and practice staff who work with Medicare claims, claim edits, and documentation that supports accurate diagnosis reporting. The piece also surveys common categories of E-code situations used to clarify the circumstances of an injury or event.
Why This Topic Matters
Understanding the CMS claim-processing update and the general role of E codes can help reduce unprocessable claims and improve the completeness of diagnosis reporting on Medicare and other payer claims.
Article Sections
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CMS directive on paper claims
Summarizes the CMS update affecting paper claims submitted on the CMS-1500 and places it in the context of existing electronic claim handling.
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Put E Codes in Their Place
Reviews the general purpose of external cause coding within ICD-9-CM and how these codes relate to the main diagnosis chapter.
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Example
Provides a sample injury-related scenario illustrating how diagnosis reporting may be documented with supporting external cause information.
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Get to Know These Crucial E Code Basics
Discusses broad background on the informational role of E codes and their relevance to claim documentation and payer review.
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Check for Common 'E' Codes in Your Practice
Lists common external cause code categories and examples that may be encountered in routine practice settings.
What You Will Learn
- How CMS guidance affects claims processing when external cause codes are placed in the primary diagnosis position
- What the article says about the general purpose of ICD-9-CM external cause coding
- Why external cause information may be included to support claim clarity and documentation
- Which broad categories of common E-code situations are highlighted for everyday practice
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Physician office staff
- Revenue cycle teams
Codes Discussed
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