brief summary of takeaways of the below postings

Our International Classification of Disease 10 (ICD10) was delayed twice and transitioned from ICD9 to ICD10 on October 1, 2015. ICD10 is more specific than ICD9. ICD9 consists of more than 71,000 diagnosis codes, and ICD10-PCS consist of more than 78,000 (Oachs and Watters, 2020). ICD10 provides better quality care for patients as it will improve clinical decision-making. It also captures more information and provides a better understanding of the complexity of the disease process.

When the 9/11 terrorist attacks happened 21 years ago the World Health Organization's (WHO) International Classification of Diseases (ICD) and the United States' Clinical Modification of the ICD, Ninth Revision (ICD-9-CM) had to take immediate actions. Prior to this terrorism was absent from the two major classification systems used for mortality and morbidity statistics. It was difficult to classify the injuries and deaths from 9/11 event using the system in place at the time. "States are contacting The National Center for Health Statistics (NCHS) for guidance on how to code and classify deaths, and hospitals are contacting NCHS for direction on how to code and classify injuries." ("ICD - Classification of Death and Injury Resulting from Terrorism", 2015).

The external cause code of injury is imperative because it captureshow the injury or health condition happened (cause), and also 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). ("ICD-10-CM Official Guidelines for Coding and Reporting FY 2022", n.d.).

When a death or injury results from an external cause, the external cause code is assigned. In the ICD-10 CM code book, external cause codes are found in chapter 20, which includes codes that start with the letters V, W, X, and Y. The terrorist Y38 categorieshave more than twenty external cause of injury codes, which are classified by the type of terrorist attack and the type of person being attacked. For example, it is specified as a terrorist, public safety or civilian. "Terrorism involving fires, conflagration and hot substances, terrorist injured Y38.3X2, and Terrorism involving explosion of marine weapons, public safety official injured Y38.0X1" etc. The Y38 became effective on October 21, 2021.

The external cause of injury code Y38.6X2, Terrorism, involving biological weapons, civilian injured. Emergencies events, and disease outbreaks will introduce new categories for disease classification. It is important that these codes are accurately reported as we need to know the cause of a person's death or injury. An event like the 9/11 attack affects our nation's safety, so it is crucial for the code to be reported for any related terrorist-related incident. HIM coding professionals are more familiar with the regular ICD10 code, but not every day HIM coding professionals will see an external cause code for Y38 Terrorism. Therefore, we need pay attention to the details on how to report this data to our government officials.

Another big event happened in 2019 with the COVID Virus outbreak. As new strains evolved, and new findings from research scientists became available, a new set of codes were added, revised and updated within a year of the outbreak. Now we also have a code for COVID 19 immunization.

The ICD10-CM and The ICD10-PCS codes have provided a better understanding of our patient's health. We can see a full picture from disease, injury, symptoms, and surgery in the ICD10-CM and ICD10-PCS. This information will help with a patient's health information management, and also support reimbursement, improve payment efficacy and prevent coding errors.

Specific codes for classifying terrorism-related events exist to track public health incidents. ICD-10-CM external cause codes are used for data and tracking public health information. With these codes various Health Care Organizations can collect data onspecific elements and use that data to provide support in public health and safety. According to Kostick (2016), "The purpose of reporting terrorism codes is to capture the terrorist element responsible for a person's injury." External cause codes are not mandatory in all healthcare settings. However, in places where it is not mandatory to report it is encouraged to volunteer these codes to supply data for injury research and evaluation of injury prevention strategies (Kostick, 2016).

The change from ICD-9 to ICD-10 came with some pushback from healthcare providers as it was new, and adjustments needed to be made in order to utilize it properly. There also needed to be training provided in order to implement its use successfully. However, with training and proper use of ICD-10 came a higher quality of clinical data. Being able to track external cause codes helps institutions like the CDC, the FBI, and local hospitalstrack data needed to support in protecting the public.

Monestime et. Al (2019) writes, "Public health's focus is aimed at setting up and keeping the highest level of health and wellness for a given population. This aim includes a focus on population care and prevention, rather than individual health outcomes". This means that with external cause codes they can use that data to support the entire population. Knowing that an outbreak might have happened in a certain area, or a specific place is more prone to gun violence can support in setting up policies, laws and preventative measures to protect the vulnerable population.

Using codes to classify terrorism-related incidents helps with public health and safety and should be documented when incidents occur.

Since 9/11, terrorism attack in US has increased and the victims among the civilians has grown, causing hospitals to been full of patient who are injure. The ICD 10 codes are used to differentiate within the patients so, the providers can provide proper care and treatment for the victims. And differentiate the patient from those who are in the hospital for other reasons than the attack. Also, this will help insurance to identify if the cause of existing conditions are due to terrorism attack. It's not covered by the insurance, but at least it will show on their medical history or existing condition. This code is also use for biological weapons, this is important code to identify those patients and to isolate them from others to prevent any further spread to other patients. If, this code is not used than unintentionally healthcare staff and other patients will be infected or even cause death. This code is necessary to help prevent any future damage or death on healthcare and other patients

ICD-10-CM is a medical coding system used in the United States by healthcare providers to classify and code diagnoses, symptoms and procedures that are done alongside hospital care. (Holman, 2022). These codes are essential to providing data on the severity of a patient's condition. There are codes classified under ICD-10-CM that are used to report injury as a result of terrorism. (Kostick, 2016). Reporting terrorism codes allows for the individual's death to be formally tracked and investigated as a terrorist/terrorist-related event. (Kostick, 2016). Terrorism codes grew greatly in necessity in the post-9/11 terrorism attacks era. The CDC also played a large role in emphasizing medical health codes in the wake of the 9/11 attacks. The codes developed played a vital role in characterizing and classifying statistically all the deaths that occurred, as well as reporting and observing any injuries, and the extent of those injuries. (CDC, 2015).

In order to classify a death as a result of terroristic nature, the incident must be classified as such by the Federal Government. The Health Information Staff at a hospital do not have the jurisdiction to designate the death as such. (CDC, 2015). For nonfatal injuries, a hospital stay is coded according to information documented by the physician who performed the services. The coded information plays an important role in statistical classifications, as well as for insurance reimbursement purposes. (CDC, 2015). Specific codes used for different scenarios allow hospitals to keep accurate data about patients in large-scale emergencies like terrorist attacks.