ICD-10-CM Coding Advice for Healthcare Encounters in Hurricane Aftermath
August 2017
This document is intended to be used as a guide to help coding professionals when coding healthcare
encounters of those individuals affected by a hurricane. This coding advice has been approved by the Four
Cooperating Parties (American Hospital Association (AHA); American Health Information Management
Association (AHIMA); Centers for Medicare and Medicaid Services (CMS); and National Center for Health
Statistics (NCHS)). The advice, originally published in 2005, has been updated and includes ICD-10-CM codes.
Further guidance will be provided, as necessary, as events unfold in the aftermath of the hurricane.
Use of External Cause of Morbidity Codes
An external cause of morbidity code should be assigned to identify the cause of the injury(ies) incurred as a
result of the hurricane. The use of external cause of morbidity codes is supplemental to the application of ICD-
10-CM codes. External cause of morbidity codes are never to be recorded as a principal diagnosis (first-listed in
non-inpatient settings). The appropriate injury code should be sequenced before any external cause codes.
The external cause of morbidity codes 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). They should not
be assigned for encounters to treat hurricane victims’ medical conditions when no injury, adverse effect or
poisoning is involved. External cause of morbidity codes should be assigned for each encounter for care and
treatment of the injury. External cause of morbidity codes may be assigned in all health care settings. For the
purpose of capturing complete and accurate ICD-10-CM data in the aftermath of the hurricane, a healthcare
setting should be considered as any location where medical care is provided by licensed healthcare
professionals.
Sequencing of External Causes of Morbidity Codes
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 injury codes. Assign as
many external cause of morbidity codes as necessary to fully explain each cause. For example, if an injury
occurs as a result of a building collapse during the hurricane, external cause codes for both the hurricane and
the building collapse should be assigned, with the external causes code for hurricane being sequenced as the
first external cause code.
