CDI Tip: Reporting Firearm Injury Intent from Other Clinicians’ Documentation 

What’s New in FY 2026? 

• CMS and ICD-10-CM guidelines now allow documentation by clinicians other than the patient’s provider (e.g., nurses, social workers, trauma team) to be used for assigning external cause codes, including firearm injury intent. 
• This change supports more accurate public health reporting and injury surveillance 

Key Actions for CDI Specialists 

• Review All Clinical Notes 
• Check ED notes, nursing assessments, social work documentation, and EMS reports for statements about firearm injury intent (e.g., accidental, assault, self-harm, undetermined). 
• Apply the New Intent Hierarchy 
• If intent is clearly documented by any clinician, code accordingly: 
• Accidental: W34 series 
• Assault: X93–X95 series 
• Self-harm: X72–X74 series 
• Undetermined: Y22–Y24 series 
• If no intent is documented, follow the updated guideline: default to undetermined intent for firearm injuries (Y24.9), unless otherwise specified. 
• Query When Needed 
• If conflicting documentation exists (e.g., ED note states “possible assault,” nursing note says “accidental”), query the provider for clarification. 
• Document Source 
• When coding based on another clinician’s note, ensure the documentation is clearly attributed in the record. 

Pro Tip: Incorporate firearm injury intent review into your trauma and ED CDI workflows. Educate providers that intent matters for coding, quality metrics, and injury prevention programs. 

Example Clinical Scenario with Query: 

Setting: ED, trauma bay 

Patient: 28-year-old male with a through and through gunshot wound of the left thigh; hemodynamically stable. 

Documentation in record:  

• ED triage RN note: “Pt states he was shot by someone outside a bar.” 
• EMS run sheet: “Bystanders report drive by shooting; single GSW to L thigh.” 
• ED SW note: “Patient reports unknown assailant; denies self-harm.” 
• ED provider note: “GSW L thigh; hemorrhage controlled; analgesia given.” Intent not specified in provider note or discharge summary 

Query: 

Documentation in the medical record shows that the patient was injured by a firearm. Please clarify the intent of the firearm injury for this encounter, based on your clinical judgment and the medical record. 

• Assault (injury inflicted by another person) 
• Accidental/unintentional 
• Intentional self-harm 
• Undetermined (unable to determine intent from available information) 
• Other (please specify): _______________________