Wiki 7th Character "A" and "D" HELP!!

[szijes6@gmail.com]

I would like to get some clarification on the use of ICD-10's 7th character "A" and "D". Its pretty self explanatory when a patient presents in the Emergency room or when an initial surgery is performed, the 7th character is "A" because they are receiving active treatment. What about in the inpatient setting, where some patients are here for months? When would I determine they are no longer receiving active treatment and start using "D"? Does anyone have experience on when I should start using the "D" subsequent encounter, is it after the first day of admission, how would I determine if the patient is no longer receiving active treatment ("A") and start using the "D" for the routine and recovery phase? Is it by date of service/encounter? I'm sure I just made this more confusing, but any help is greatly appreciated.


Thanks
-J

 

[mitchellde]

If you are coding for the facility then it will be the A for the admission. If you are coding for the physian then once the surgery is performed, the follow up visits are coded as subsequent.

 

[AlaskanCoder]

Sometimes you may not surgery, so it becomes a little harder when you are coding for the physician to determine when to move to the 7th character of D. I think of D as the healing phase, because, once the patient has had surgery for an injury, we anticipate healing to begin. So, if, for instance, my trauma doctors have a patient who has head trauma once neurology has determined that surgical intervention is not required, I switch from active treatment "A" to healing "D". In my experience, it is very rare that a certain provider will see a patient more than 2 or 3 times for active treatment. This is specifically for professional services, not facility. I am not, at all, versed in facility ICD-10-CM coding.