7th character- intial vs subsequent

ladymatthew

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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.
 

mitchellde

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This was clarified for in the coding guidelines Nov of 2014.
While the patient may be seen by a new or different provider over the course of treatment for an injury, assignment of the 7th character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time.
If your provider was performing follow up care for a patient treated in the ER then your 7th character would be subsequent. However if the ER only stabilized the fracture and sent them to you for fracture care then it is still active when you see them in the office and still active when they are taken to the OR. ICD-10 CM codes are patient diagnosis codes not provider encounter codes. So when the patient goes to the ER with an injury, that is the patients initial encounter for active treatment. If the ER is unable to successfully treat the fracture and only applies comfort care, telling the patient to then go to your office, When the patient crosses your threshold they are still seeking active treatment for an active untreated injury. When your provider cannot manage the injury in the office and schedules surgery, then the patient is in the OR still seeking active treatment for a still untreated injury.
 

ladymatthew

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This was clarified for in the coding guidelines Nov of 2014.
While the patient may be seen by a new or different provider over the course of treatment for an injury, assignment of the 7th character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time.
If your provider was performing follow up care for a patient treated in the ER then your 7th character would be subsequent. However if the ER only stabilized the fracture and sent them to you for fracture care then it is still active when you see them in the office and still active when they are taken to the OR. ICD-10 CM codes are patient diagnosis codes not provider encounter codes. So when the patient goes to the ER with an injury, that is the patients initial encounter for active treatment. If the ER is unable to successfully treat the fracture and only applies comfort care, telling the patient to then go to your office, When the patient crosses your threshold they are still seeking active treatment for an active untreated injury. When your provider cannot manage the injury in the office and schedules surgery, then the patient is in the OR still seeking active treatment for a still untreated injury.
thank you Ms Debra! that is what I thought! It will always be active treatment for their first encounter with us because the ER only provides comfort care and sends them to us for definitive treatment. Thank you again for your time!
 

CodingKing

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If you have access to coding clinic. I was told Volume 2, First Quarter, Number 1, 2015, Page 3-?. I guess there are many pages addressing the 7th digit.

When they see you its not in the healing or recovery phase so its A. Examples of D are cast changes, x-rays to check healing status, rehabilitation services (except when its Sequela) etc.
 
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