ary consequence or result). The applicable seventh character is
required for all external cause codes within the category or as
the tabular list notes instruct.
An external cause code with the appropriate seventh character is assigned for each encounter for which the injury or condition is being treated. If a code requires a seventh character but
is not six characters long, a placeholder X is used to fill in the
empty character.
When reporting transport accident section codes (V00–V99),
the tabular list instructs coding professionals to use an additional code to identify an airbag injury (W22.1), type of street or
road (Y92.4-), and use of cellular telephone and other electronic
equipment at the time of the transport accident (Y93.c-). Land
transport accidents (V01–V89) specify the injured individual’s
mode of transport and are subdivided to identify the injured individual’s “counterpart” or the type of event. The type of vehicle
the injured person occupies is identified in the first two characters since it is seen as the most important factor to identify for
prevention purposes.
The complications of medical and surgical care categories
(Y62–Y84) do not require seventh-character extensions. This
section includes a new category to report medical devices associated with adverse incidents in diagnostic and therapeutic use
(Y70–Y82). This category includes the breakdown or malfunction of medical devices after implementation.
The supplementary factors related to causes of morbidity classified elsewhere categories (Y90–Y99) may be used to provide
supplementary information concerning causes of morbidity.
They are not to be used for single-condition coding.
For example, a note under category Y90 titled “Evidence of alcohol involvement determined by blood alcohol level” instructs
coders to first code any associated alcohol-related disorders
from category F10. The familiar ICD-9-CM E codes for place of
occurrence, activity, and status are included in this ICD-10-CM
section.
New and Revised Coding Guidelines
Many of the Official Guidelines for Coding and Reporting for
External Causes of Morbidity in chapter 20 of ICD-10-CM are
consistent with the ICD-9-CM E coding guidelines. A few new
and revised coding guidelines for chapter 20, “External Causes
of Morbidity,” are highlighted below.
External cause code used for length of treatment. Assign
the external cause code with the appropriate seventh character
(initial encounter, subsequent encounter, or sequela) for each
encounter for which the injury or condition is being treated.
(Coding Guideline I.C. 20.a. 2)
Combination external cause codes. Certain external cause
codes are combination codes that identify sequential events
that result in an injury, such as a fall that results in striking
against an object. The injury may be due to either event or both.
The combination external cause code should correspond to the
sequence of events, regardless of which caused the most serious
injury. (Coding Guideline I.C. 20.a. 7)
Coding Notes
Chapter 20 Tabular List Example
V44 CAR OCCUPANT injured in collision with heavy
transport vehicle or bus
Excludes 1: car occupant injured in collision with military ve-
hicle (V49.81)
The appropriate seventh character is to be added to each
code from category V44.
A initial encounter
D subsequent encounter
S sequela
V44.0 Car driver injured in collision with heavy transport
vehicle or bus in nontraffic accident
V44.1 Car passenger injured in collision with heavy transport vehicle or bus in nontraffic accident
V44.2 Person on outside of car injured in collision with
heavy transport vehicle or bus in nontraffic accident
V44.3 Unspecified car occupant injured in collision with
heavy transport vehicle or bus in nontraffic accident
V44.4 Person boarding or alighting a car injured in collision with heavy transport vehicle or bus
V44.5 Car driver injured in collision with heavy transport
vehicle or bus in traffic accident
V44.6 Car passenger injured in collision with heavy transport vehicle or bus in traffic accident
V44.7 Person on outside of car injured in collision with
heavy transport vehicle or bus in traffic accident
V44.9 Unspecified car occupant injured in collision with
heavy transport vehicle or bus in traffic accident
Coding a Transport Accident, Initial Encounter
A driver of a car collided with a bus on a business street
during rush hour traffic. The driver stated to being on his cell
phone at the time of the accident.
Codes to report this transport accident include:
V44.5xxA Car driver injured in collision with heavy trans-
port vehicle or bus in traffic accident
Y92.414 Local residential or business street as the
place of occurrence of the external cause
Y93.c2 Use of cellular telephone and other electronic
equipment at the time of the transport accident
No external cause code needed in certain circumstances.
No external cause code from chapter 20 is needed if the external
cause and intent are included in a code from another chapter
(e.g., T36.0x1-, Poisoning by penicillins, accidental (
unintentional)). (Coding Guideline I.C. 20.a. 8)
Unknown or undetermined intent. If the intent (accident,
self-harm, assault) of the cause of an injury or other condition
is unknown or unspecified, code the intent as accidental. All
transport accident categories assume accidental intent.
External cause codes for events of undetermined intent are
