Improving External Cause of Injury Coding Position Statement

Each year nearly 50 million injuries require medical treatment in the United States; 2 million of these incidents require hospitalization. Annual medical costs for injuries exceed $80 billion in the US. In addition to these many treatable injuries, 150,000 people die each year in the US due to injuries and violence. More than 40,000 Americans die each year from traffic-related injuries, almost 20,000 from falls, another 20,000 deaths are poison-related, and 50,000 die each year from suicide and homicide.

However, due to limited injury epidemiological capacity at many state health agencies, capturing detailed state and local injury patterns often remains elusive. Therefore, accurately and thoroughly coded hospital discharge data become a critical tool for understanding regional and national injury and violence trends. Enhancing these hospital-based injury-cause data are fundamental to advancing injury prevention efforts at the state and local level. As a result, statewide hospital discharge databases are a core dataset recommended for injury surveillance by state health departments. A crucial surveillance tool is the external cause of injury code (e- code).

Hospital discharge data are coded using the International Classification of Diseases Clinical Modification, revision 9 (ICD-9-CM), which provides codes to specify both the nature of the injury (e.g. skull fracture) and the mechanism or external cause (e.g. bicycle collision with motor vehicle). Without properly noted e-codes, public health researchers are limited in their ability to infer causes of particular injuries, hindering state health agencies’ opportunities to appropriately target, prioritize, and plan prevention initiatives. Improved e-coding is critical for pubic health leaders and policymakers to identify and address the key causes of injuries that present significant health and economic burdens to the nation.

Presently, the external cause code is not consistently or uniformly included in hospital discharge databases. In 2005, only 26 states mandated e-coding, and in states that have evaluated their systems, only 55% of statewide hospital emergency department datasets have an e-code for more than 90% of injury records. Even when e-codes are present, the use of non-specific codes greatly limits their utility.

Position

• Hospitals should record the external cause of injury code for each hospital admission, both inpatient and outpatient, for which an injury is the primary or secondary diagnosis.
• Public health organizations should endorse, promote, and advocate for the complete and specific e-coding in statewide hospital discharge databases; such completion may
• require enhanced workforce development and training for coders.
• State public health agencies should include e-codes as a separate data element which should accompany nature of injury codes in all state hospital discharge data.
• Federal agencies should support a strategy to improve the completeness and specificity of e-coding in hospital discharge databases, including the exploration of federal data systems and uniform billing procedures as tools to achieve this aim.
• State public health agencies should use e-coded data to develop targeted prevention initiatives which address the state’s priority issues, may better achieve demonstration of health impact, and can ultimately serve to make the case for increased prevention dollars.

Approval History:

ASTHO Position Statements relate to specific issues that are time sensitive, narrowly defined, or are a further development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate Policy Committees and approved by the ASTHO Executive Committee. Position statements are not voted on by the full ASTHO membership.

Prevention Policy Committee Review and Approval on September 14, 2007

Executive Committee Review and Approval on October 2, 2007

Policy Expires on October 2, 2010

For further information about this Position Statement, please contact ASTHO Prevention Policy staff at prevention@astho.org.

Related Documents and Resources:

ASTHO Policy Statements: Prevention Policy Statement