9/11: Never Forget

I can’t believe it has been 17 years since that horrific day.  I think most of us remember what we were doing and how we felt when we saw the news.

I remember turning on the t.v. right when the second plane hit. I sat there, stunned, trying to make heads or tails at what was happening. But I knew in the back of mind that the world as we knew it was about to change. This was an event with long reaching ramifications in many, many ways.

In the healthcare world, health data was suddenly presented with a new challenge. There was now an urgent need for a classification to characterize and report injuries, sequelae of injuries, and deaths as a result of terrorism. At the time, there was no individual way to classify these types of mortalities and morbidities.

The National Center for Health Statistics (NCHS)  responded by forming an Ad Hoc Workshop on the Classification of Death and Injury Resulting from Terrorism. This group, along with the World Health Organization’s (WHO) Collaborating Center for the Classification of Diseases for North America, developed the framework within ICD-10 (mortality) and ICD-9-CM (morbidity) that would allow identification of deaths from terrorism on death certificates as well as injuries and conditions stemming from terrorism on medical records.

This system came into effect on October 1, 2002.

To classify a death or an injury as terrorism-related, the incident must be designated as such by the Federal Government as defined by the Federal Bureau of Investigation (FBI):

“Injuries resulting from the unlawful use of force or violence against persons or property to intimidate or coerce a Government, the civilian population, or any segment thereof, in furtherance of political or social objectives.”

In ICD-10-CM, Y38 Terrorism codes are classified by the type of terrorist attack, such as:

Y38.1 - Terrorism involving destruction of aircraft
Y38.6 - Terrorism involving biological weapons

These codes can be further classified by the type of person injured (7th character extension indicating episode of care must be included – initial (A), subsequent (D), or sequela (S)):

Y38.1X2_ - Terrorism involving destruction of aircraft, civilian injured
Y38.6X3_ - Terrorism involving biological weapons, terrorist injured
Y38.811_ - Terrorism involving suicide bomber, public safety official injured

The Tabular Index also notes to use additional code for place of occurrence, such as:

Y92.22 - Religious institution as the place of occurrence of the external cause
Y92.59 - Office Building as the place of occurrence of external cause

Chapter-specific guidelines are listed in ICD-10-CM also must be taken into consideration when choosing the most appropriate code, or sequencing more than one code:

  • Y38 Terrorism codes are not to be sequenced as the first-listed or principal diagnosis as they are intended to be used secondarily to a code from another chapter indicating the nature of the condition. For terrorism incidents, the nature of the condition will usually be classifiable to Chapter 19, Injury, poisoning and certain other consequences of external causes (S00-T88).
  • When the cause of an injury is suspected to be the result of terrorism a code from Y38 should not be assigned. Suspected cases should be classified as assault.
  • More than one code from Category Y38 may be assigned if the injury is the result of more than one mechanism of terrorism.
  • External cause codes for terrorism events take priority over all other external cause codes except child and adult abuse.
  • Only report Y38.9 – Terrorism, secondary effects, for conditions occurring subsequent to the terrorist event.
  • Y38.9 – Terrorism, secondary effects, may be used secondarily with another code in Y38 if there is an injury due to the initial terrorist event and the injury is subsequent to the initial even.

As we reflect back on this brutal day, let’s hope and pray that one day these codes in the back of a coder’s book will never see the light of day.


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