Mechanism- External Cause of Injuries


Thanks for returning for Part IV of the “Documentation as a Habit”  series.

This is the fourth week of this series where we have paused to take a look at the need for EMS agencies to be intentional about Patient Care Report documentation reviews.

In this series, we lasered in on how field documentation in the Patient Care Report (PCR) directly ties to your billing office’s ability (or lack thereof) to apply the correct ICD-10 diagnosis code.

So far, we have taken a look at the importance of properly identifying the location and severity of illnesses and injuries. This week, we will discuss mechanism and documenting the precise external cause of injuries.

40 Pages, over 4,000 codes

Visit your EMS billing office someday and ask to see the ICD-10 coding book. The physical, hard copy publication is huge. Literally a person who is linear challenged could stand on this thing to reach high places.

The chapter containing the “External Cause of Injuries Index” of codes spans 40 pages and if our estimates are accurate exceeds 4,000 individual codes intended to capture the exact nature of accidents and resulting injuries.

Mind Blowing!

There are so many possible ways your patients suffer injuries. The causes of those injuries combine for so many possible scenarios, just thinking about it can be staggering. Now sit down and put them all on paper and then come up with a way to digitally represent those scenarios with an alpha/numeric representation.

Mind blowing! Right?

Now imagine sitting in the billing office, reading PCRs and it’s your job to choose one of these over-4,000 choices to accurately represent the EMS scenario to the insurance payer source when billing.

It’s a daunting task.


We thought you’d enjoy reading some of the examples of the codes that are out there to choose from.

Let’s say you are an EMS provider in San Francisco where there are streetcars. Well, there are specific codes for injuries suffered on the streetcar. Code V82.4 is a code set aside for an accident, transport, streetcar occupant, collision while boarding or alighting.

For those of us that practice in Amish Country, like Pennsylvania or Ohio, your billing office probably uses V36.9 or V36.3 which is the code for an accident caused by an animal-drawn vehicle in traffic (V36.9) or when not in traffic (V36.3.)

The “struck by” codes apply to many of our scenarios such as codes for struck by a… baseball, bullet, lightning, missile (an everyday occurrence for sure), tennis racquet (and there’s a separate carve-out code for an assault with a tennis racquet- really?)

Are you getting the picture?

If you are less than detailed when documenting your injury scenario, your billing office will be hard-pressed to choose the correct code when preparing the claim.

Let’s say you handled a construction accident. It’s not enough to simply state that the patient suffered a laceration from contact with a machine. Why? Because there are separate codes for different types of machines. For example, there is a code for a wound where the mechanism of injury was due to contact with a bench-saw and then there is another code for contact with a band-saw.

Of course, let’s not forget that once you have described what or how the injury was caused, then you have to combine the other elements that we have or will be discussing in the coming weeks by describing in succinct detail the location of the injury, the severity, causation, relationship and even the stages- if applicable.

Even the place of occurrence has codes almost three pages of the coding book contain those codes and include every type of possible location where an incident can take place. There are separate codes for church versus mosque, a code for an injury that takes place in the mall and another for the injury at a radio station, just to name a few.

The coding combinations and considerations are endless. But, simply it all comes down to how much detail you include in your PCR documentation. That one thing is the common denominator that will end in a successful outcome and payment for the service you provided.

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