Basic ICD-9-CM Coding Workshops
June 2013
Irene Mueller
E CODES
E codes are used to indicate the 1) drug responsible for an adverse effect, 2) substance causing poisoning,
3) external cause of an injury, 3) intent (accidental or intentional, 4) cause of a residual condition, 5) place of
occurrence of transportation accidents, and 6) person’s status.
Injuries are a major cause of mortality, morbidity, and disability and contribute significantly
to healthcare costs. Reporting E codes provides data for injury research and evaluation of
injury-prevention strategies. Activity codes (E001-E030) are to be used to describe the
activity of a person seeking care when the condition/injury resulted from an activity or the
activity contributed to a condiditon. Reporting E codes for injuries is optional unless
mandated by states or payors, providers are strongly urged to report all initial treatment of injuries, following
guidelines. ICD-9-CM E codes are being adjusted to correspond with ICD-10-CM uses.
E codes are NEVER principal diagnoses.
E codes are NEVER assigned by themselves, a related code MUST BE assigned first.
E codes can be assigned as additional codes with any code from 001-999.
If two or more events cause separate injuries, an E code should be assigned for each, with the proximal
(direct) cause listed first.
When conditions have multiple E codes, sequence them in the following order. E codes for child and adult
abuse take precedence over ALL OTHER E codes, then terrorism events, then cataclysmic events E codes
(storms, floods, hurricanes, tornadoes, blizzards, volcanic eruptions, and earth surface movements), then
transport accident E codes.
If two or more events cause separate injuries, an E code should be assigned for each, with the proximal
(direct) cause listed first.
E codes (E930-E949) for drugs in adverse reactions are mandatory - (MUST be assigned).
E codes for burns are strongly encouraged, required in several states, and in ALL accredited trauma centers.
Locating E codes
The E code index uses the same format and convention of the main AI. Key main terms include ACCIDENT,
ASSAULT, COLLISION, FALL, FIRE, INJURY, REACTION, SUICIDE, etc.
Burns are E coded to indicate the type of substance causing the burn: open flame, acidic or corrosive
substance, hot object, etc. When a late effect of burn code is used, a late effect E code should also be used.
Fires are E coded as controlled or uncontrolled (Conflagration).
Exposures to environmental factors are E coded.
Basic ICD-9-CM Coding Workshops
June 2013
Irene Mueller
E869.4 identifies a nonsmoker whose doctor states that environmental tobacco smoke is the external cause of
the patient's condition. Example, a child admitted with status asthmaticus, and the doctor states she was
exposed to cigarette smoke for several hours on the day of admission.
Falls are E coded to indicate the area FROM and/or the area TO.
Intentional injuries are E coded as self-inflicted (E950-E959) or inflicted (E960-E969) by another person.
E980-E989 codes are used is the intent is unknown, unspecified, suspected, possible, or probable.
Transportation-related If an accident involves more than one major type of vehicle, there is a pre-ranked
order to how the accident is reported. For example; an accident between a car and a train is classified as a
MVA, an accident between a car and an airplane is classified as an aircraft accident. These sequencing
guidelines are at the beginning of the E code TL.
Examples
A patient was admitted with a fracture of the left femur shaft, suffered when he stepped backwards and fell
from the top of the stairs during a fight.
A woman was admitted with a fractured arm, suffered when the car she was driving hit a tree during a
tornado.
A patient was admitted with a fracture of the left femur shaft, suffered when he stepped backwards and fell
from the top of the stairs during a fight.
A woman was admitted with a fractured arm, suffered when the car she was driving hit a tree during a
tornado. The proximal cause was the MVA, but the code for tornado is sequenced first because a cataclysmic
event takes precedence
A patient came to the hospital by ambulance after a fall from scaffolding while working on the construction of
a new bank building. He had struck his head and experienced a brief period of unconsciousness( < 1 hour).
He was found to have an open skull fracture with cerebral laceration and contusion. The skull fracture was
reduced after debridement.
A patient was admitted for corrective surgery for a keloid of the left hand due to a burn experienced in a brush
fire one year ago. Radical excision of the scar was carried out, and the defect was covered with a fullthickness graft taken from the upper arm.
A patient was admitted for observation and evaluation for possible intracranial injury following a collision
with another car while he was driving to work. Patient had minor bruises on the upper back and abrasions of
the skin of the upper extremity. The bruises did not appear to need any tx; the abrasions were swabbed with
disinfectant and Neosporin was applied. Intracranial injury was ruled out.
A 10-y-o boy was admitted because of severe cellulitis of the left leg. He had been on a scout hiking trip in
the woods a week earlier and had several minor thorn punctures, but had no problem with them. The day
before admission he had developed a painful swollen area on the left leg, that worsened during the night.
Antibiotics were administered over 2 days to treat Streptococcus A cellulitis.