T07-T88 — Injury, poisoning and certain other consequences of external causes

The 7th character in T07-T88

A code in this block is not complete without its 7th character, and a missing one is a rejected claim rather than a denied one: the clearinghouse never passes it on. 14,279 of the 14,543 codes here take one.

A

initial encounter

D

subsequent encounter

S

sequela

Risk adjustment in T07-T88

0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.

• HCC 155 Major Depression, Moderate or Severe, without Psychosis
• HCC 385 Severe Skin Burn or Condition
• HCC 137 Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
• HCC 409 Amputation Status, Lower Limb/Amputation Complications
• HCC 221 Heart Transplant Status/Complications
• HCC 276 Lung Transplant Status/Complications

What else to watch in T07-T88

• 2,517 codes are laterality-specific. They come in left and right pairs, and the pair is mutually exclusive on a single site: coding both without a bilateral code is a contradiction a scrubber should catch before the payer does.
• 9,667 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.