FPs: Learn How to Use Hurricane 'External Cause' Codes

New Guidelines Now in Effect

October 01, 2018 01:45 pm News Staff

Residents along the Eastern Seaboard are still dealing with the aftermath of Hurricane Florence, a powerful storm that made landfall Sept. 14 near Wrightsville Beach, N.C.

[Hurricane image from space]

And given that two months remain in the 2018 Atlantic hurricane season -- which officially ends on Nov. 30 -- family physicians should be aware that the CDC's National Center for Health Statistics recently updated its guidelines regarding hurricanes.

The new guidelines(www.cdc.gov) went into effect on Oct. 1; the guidance specific to health care encounters in the aftermath of a hurricane can be found on pages 19-20.

AAFP Coding and Compliance Strategist Barbara Hays, C.P.C., told AAFP News that the external cause codes referenced in the guidance have been in place since the ICD-10-CM code set was implemented on Oct. 1, 2015.

However, the new guidelines give physicians clear direction on how to use them.

"Most payers do not attach payment directly to ICD-10-CM diagnosis codes at this time," said Hays. "So it is important that billing staff and physicians verify if these codes, or any diagnosis code, affects their payment.

"However, any ICD-10-CM code used correctly allows the physician to accurately tell the patient's story," said Hays.

For instance, when the physician attaches the appropriate ICD-10 code, that code makes it clear how a patient broke a leg or sustained a gash on the arm that required medical attention, she explained.

The guidance is broken down by section and includes details on

  • use of external cause of morbidity codes,
  • sequencing of external causes of morbidity codes,
  • other external causes of morbidity code issues, and
  • use of Z codes.

For those unfamiliar with the terminology, Z codes may be assigned to further explain why a patient presented for health care services. For example, some applicable Z codes include

  • Z59.0 -- homelessness,
  • Z59.1 -- inadequate housing,
  • Z59.5 -- extreme poverty, and
  • Z75.1 -- unavailability and inaccessibility of health care facilities.

In addition, using external cause codes on death certificates is an appropriate use of the ICD-10-CM code set. Depending on state formatting and requirements, for example, there may be options to indicate an underlying cause of death and/or note whether significant existing conditions contributed to the death.

Related to specifically to Hurricane Florence, on Sept. 14, CMS issued a press release(www.cms.gov) detailing the agency's ongoing efforts to help with emergency response. Those actions include

  • temporarily waiving or modifying certain Medicare, Medicaid and Children's Health Insurance Program requirements;
  • creating special enrollment opportunities for individuals to access health care immediately; and
  • taking steps to ensure dialysis patients were able to obtain services.

Related AAFP News Coverage
AAFP Releases Updated Disaster Preparedness Resources
Family Physician Recounts Hurricane Survival Lessons


Additional Resources
CMS: Hurricanes and Tropical Storms(www.cms.gov)

CMS: Waivers and Flexibilities(www.cms.gov)

CMS: Hurricane Resources From the Office of the Assistant Secretary for Preparedness and Response(www.cms.gov)