General question- I work for an orthopedic practice and pts come to us with acute injuries, however these injuries are most always treated in the emergency room first- labeling that visit the initial encounter. When they seek treatment with us for the first time is that still considered initial encounter? because we are a new treating physician and the pt is still in the active treatment phase? or does is become subsequent? For example: pt falls and breaks his ankle and was referred to us from emergency room. We examine, take xrays and schedule him for surgery or place him in a cast...... we had a disagreement in our office as to whether or not this bodes letter A as 7th character for initial or D for subsequent encounter. Can anyone please clarify for me? thank you so much... if you have reference to coding clinics as well it would be greatly appreciated.