2025 ICD-10-CM code Y92.19
Other specified residential institution as the place of occurrence of the external cause.
No modifiers are applicable to this code.
The medical necessity for this code is established by the need to accurately document the circumstances surrounding the event. Y92.19 provides additional information about the place of occurrence but it does not impact medical necessity which is primarily determined by the diagnosis code for the injury or illness itself.
It is the clinician's responsibility to accurately document the place of occurrence and the nature of the condition to support the use of Y92.19 with the appropriate primary diagnosis code.
In simple words: This code indicates that the cause of injury or illness happened in a residential institution setting, such as a group home or assisted living facility, but not a private home or halfway house. It's used to give extra detail about where the event took place, not what the actual injury or illness is.It must be used with another code that describes the specific medical problem.
This code identifies a specific type of residential institution, other than a single-family home or a halfway house, as the location where an external cause of injury or illness occurred.It is used to provide additional information about the circumstances surrounding the event but does not describe the nature of the condition itself.This code must be used in conjunction with a code from another chapter that describes the condition.
Example 1: A patient falls and breaks their hip while residing in a nursing home. The primary code would be for the fracture (e.g., S72.151A, Displaced fracture of neck of right femur, initial encounter for closed fracture) and Y92.19 would be used as a supplementary code to indicate the place of occurrence., A resident of a group home for individuals with intellectual disabilities develops a pressure ulcer.The primary code would be for the pressure ulcer (e.g., L89.102, Pressure ulcer of right buttock, stage 2) and Y92.19 would be a supplementary code., A patient in a long-term care facility experiences a medication adverse effect. The primary code would be for the adverse effect (e.g., T36.0X5A, Adverse effect of penicillin, initial encounter) and Y92.19 would be used as a supplementary code.
Documentation should clearly state the nature of the injury or illness, the specific residential institution where the event occurred, and the circumstances surrounding the event.
** This code is part of a series of codes under Y92 used to specify place of occurrence. It is important to use the most specific code available. For instance, if the specific type of residential institution is known (e.g., a nursing facility), the appropriate specific Y92.1 code should be used instead of Y92.19.
- Payment Status: Billable
- Modifier TC rule: No TC modifier applies to this code.
- Specialties:Any specialty providing care in a residential institution setting can use this code, including but not limited to: Internal Medicine, Geriatrics, Family Medicine, Physical Medicine and Rehabilitation.
- Place of Service:"Nursing Facility", "Skilled Nursing Facility", "Assisted Living Facility", "Custodial Care Facility", "Group Home", "Intermediate Care Facility/Individuals with Intellectual Disabilities" ,"Residential Substance Abuse Treatment Facility","Psychiatric Residential Treatment Center"