7th character help for injury codes

[jackiemal]

I code for an urgent care center in an area with a lot of senior citizens. They come in for skin tears and usually can't be sutured because of thin skin. Some of them, even though not requested to by the provider, come in every two days for a wound check. Sometimes the provider notes to continue applying Bacitracin and sterile dressing. Sometimes the provider just states to follow up with their PCP but they still come back to us for a wound check.

When do I use the 7th character D in situations like these?

Thank you!

 

[cgaston]

I found this to be helpful:

When to use which 7th Character?

A, Initial encounter
Initial encounter is used when the patient is in the active phase of receiving treatment. For any surgical procedure, emergency encounters, etc. It is important to note that this extension refers to the patient’s initial encounter with the injury and not with the physician. Even if the patient visits three different physicians but is still in the active phase of receiving treatment, initial encounter will be used.

Let’s suppose you are coding for a patient with (Strain of right Achilles tendon, S86.011). Following would be the code structure in this scenario:

Patient gets admitted into the emergency room and the ED physician diagnosis him with S86.011A, Strain of right Achilles tendon, initial encounter.

The patient then goes to the radiology department to get his X-rays and lab work done. The code used at this stage would again be S86.011A, Strain of right Achilles tendon, initial encounter.

The physician splints patient’s ankle and asks him to consult an orthopedic surgeon. The patient visits the orthopedic surgeon 2 days later and discusses his further treatment. At the end of the discussion a surgery is scheduled next week. The surgeon would report this visit using the code S86.011A, Strain of right Achilles tendon, initial encounter.

Finally a surgery is performed as scheduled. This surgical procedure would again be coded as S86.011A, Strain of right Achilles tendon, initial encounter.


D, Subsequent encounter
Subsequent encounter is used when the patient has progressed into the healing/recovery stage and is no longer in the active phase. It involves suture removals, routine checkups after the injury, any changes in medication or follow up visits made to the physician’s clinic.

Let’s continue with the same example as above

After the surgery the patient gets admitted in the hospital for a few days until he is well recovered. Now that he is in the recovery phase the code would be a subsequent encounter S86.011D
The patient then gets discharged from the hospital and visits later to get his stitches removed and get his pain medication adjusted. The code reporting this visit would be S86.011D indicating a subsequent encounter.
Remember that these extensions initial and subsequent have nothing to do with the established or new patient visits mentioned in CPT codes.



S, Sequela
Sequela is used when any complication or condition arises directly as a result of a condition. Most common example of which is scarring of skin post a burn. Coding for sequela isn’t time specific since they can appear as early as a week or may even take up to years depending on the injury which caused it. When coding this extension make sure to follow the below mentioned order:

First code the condition or nature of the sequela
Second code the sequela code itself


Hope it helps you too!