ICD-10 Coding Advice for Hurricane Injuries

If you are treating patients for hurricane-related injuries or illnesses, here is some timely ICD-10 coding guidance from the Centers for Disease Control and Prevention.

Use external cause of morbidity codes. Assign an external cause of morbidity code to identify the cause of the injury(ies) incurred as a result of the hurricane, supplemental to the application of ICD-10-CM codes.

  • Never record an external cause of morbidity as a principal diagnosis (first listed in non-inpatient settings). Sequence the appropriate injury code before any external cause codes (see below).
  • Use the external cause codes to capture how the injury or health condition happened (cause); the intent (unintentional or accidental; or intentional, such as suicide or assault); the place where the event occurred; the activity of the patient at the time of the event; and the person’s status (e.g., civilian, military). Do not assign these codes for encounters to treat hurricane victims’ medical conditions when no injury, adverse effect, or poisoning is involved.
  • Assign an external cause of morbidity code for each encounter for care and treatment of the injury. The codes may be assigned in all health care settings, which in the post-hurricane context is any location where licensed health care professionals provide medical care.

Sequence external cause of morbidity codes correctly. Codes for cataclysmic events, such as a hurricane, take priority over all other external cause codes except child and adult abuse and terrorism and should be sequenced before other external cause of morbidity codes.

Assign as many external cause codes as necessary to fully explain each cause. For example, if an injury occurs as a result of a building collapse during the hurricane, assign external cause codes for both the hurricane (first in sequence) and the building collapse.

For injuries incurred as a direct result of the hurricane: 

  • Assign the appropriate code(s) for the injuries, followed by the code X37.0- Hurricane (with the appropriate seventh character), and any other applicable external cause codes.
  • Also assign Code X37.0- when an injury was a result of flooding caused by a levee breaking related to the hurricane.
  • Assign Code X38. Flood (with the appropriate seventh character), when an injury is from flooding resulting directly from the storm.
  • Do not assign Code X36.0- Collapse of dam or man-made structure, when the cause of the collapse is due to the hurricane. Use of code X36.0- is limited to collapses of man-made structures due to earth surface movements, not due to storm surges directly from a hurricane.  

For injuries not a direct result of the hurricane, such as an evacuee injured in a car collision:  

  • Assign the appropriate external cause of morbidity code(s) to describe the cause of the injury, but do not assign code X37.0- Hurricane.
  • If it is not clear whether the injury was a direct result of the hurricane, assume it is and assign code X37.0- as well as any other applicable external cause of morbidity codes, e.g.:
    • W54.0- Bitten by dog,
    • X30- Exposure to excessive natural heat,
    • X31- Exposure to excessive natural cold, or
    • X38- Flood.

Use Z codes as appropriate. Assign Z codes (other reasons for health care encounters) to further explain the reasons for presenting for health care services, including transfers between health care facilities. The ICD-10-CM Official Guidelines for Coding and Reporting identify which codes maybe assigned as principal or first-listed diagnosis only, secondary diagnosis only, or principal/first-listed or secondary (depending on the circumstances). Among possible applicable Z codes are:

  • Z59.0, Homelessness,
  • Z59.1, Inadequate housing,
  • Z59.5, Extreme poverty,
  • Z75.1, Person awaiting admission to adequate facility elsewhere,
  • Z75.3, Unavailability and inaccessibility of health care facilities,
  • Z75.4, Unavailability and inaccessibility of other helping agencies, and
  • Z76.2, Encounter for health supervision and care of other healthy infant and child.

Because patient history information may be limited, use any available documentation to assign the appropriate external cause and Z codes. See the ICD-10-CM Official Guidelines for Coding and Reporting for further guidance regarding the use of ICD-10-CM diagnosis codes, including external cause of morbidity and Z codes.

Find more information for physicians about Hurricane Harvey in TMA’s Disaster Preparedness and Response Resource Center. If you have coding questions, contact the TMA’s reimbursement specialists at paymentadvocacy[at]texmed[dot]org, or call the TMA Knowledge Center at (800) 880-7955. If you’d like to schedule an in-depth coding and documentation review, contact TMA Practice Consulting at (800) 523-8776 or practice.consulting[at]texmed[dot]org.

Published Sept. 28, 2017

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Last Updated On

September 29, 2017