Medical Billing & Coding Reminder: “E” Codes Cannot Be Primary Dx

ICD-9 diagnosis codes that begin with an “E” indicate the external causes of injuries and poisonings, as well as the adverse effects of drugs and substances. For example, E905.3 is used to report a hornet/wasp/bee sting; E880.0 for a fall from stairs or escalator;  E851 for accidental poisoning by barbiturates.  E codes are meant to be used as supplemental codes – never the primary diagnosis – and serve an informational purpose for researchers collecting data on injuries and injury prevention strategies. While E codes are used to track important information, the primary diagnosis code on a claim must fall within the range of 001 – V91 and capture the actual medical indication or health condition for which care is being provided. As an example, if a patient comes to the office with a sprained ankle after an accidental fall from a ladder, the primary diagnosis would be for the sprain (845.00 – 845.09), and the secondary code would report the cause of injury (E881.0).

On August 8, 2012, the Centers for Medicare & Medicaid Services (CMS) published Change Request 7700 that instructs Medicare contactors to return as unprocessable any claims submitted on the CMS-1500 Form where an ICD-9 “E” Code is reported as the first/principal diagnosis on the claim. Claims submitted electronically with an “E” Code in the primary position have been rejecting as unprocessable since April 1, 2012. NOTE: This ruling also applies to the ICD-10 code set for external causes of morbidity, codes V00-Y99.