Wiki 7th place A or P

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jdibble

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My doctor saw the patient in the office for fractured Humerus and determined that the patient needed surgery. The patient had other medical conditions, so the surgery was not done for another 3 weeks until she was cleared. At this time the patient now has a malunion of the fracture. The doctor did hemiarthroplasty and a bone graft to repair the malunion.

My question is which 7th digit do I use? Since the patient is having surgery, I would normally use the A. However the CPT code for the bone graft is for a repair of the malunion - which would be a P!

Any suggestions?

Thanks,
 
If I understand your post correctly, the patient was seen twice - once for assessment of the fx and once for surgery. I would code A for the original visit and P for the surgery Dx

Did the doc know it was malunion at the time of the first visit?
 
At the original visit, the fracture was not a malunion. However, due to medical reasons the patient could not have surgery right away and the delay caused the malunion. So, the surgery was actively treating the fracture which also was a malunion.

This is where my confusion lies! A for actively treating or P for a malunion? Or would I use both?
 
The guidelines state "active treatment" and surgery is an example of active treatment in the guideline and I would use A. You may want to submit it with notes so if the payer has an edit that would cause a denial with the DX.

Stephanie Moore, CPC, CPMA
Vice President Seacoast Dover NH AAPC Chapter
 
AHA says...

Today I listened to a Webinar on Injuries 7th Characters, Aftercare, Follow-up and Sequelae from AHA Central Office. According to AHA, in this scenario the correct 7th character would be P!!

According to the guidelines, AHA states that if the patient themselves delayed seeking treatment causing the malunion, then the 7th character would be A. Otherwise in the following example they state:
- Patient presents for surgical treatment of a malunion
- First time surgically treated
- Patient did not delay treatment
Seventh character P, subsequent encounter for fracture with malunion.

Official Coding Guideline: 1.C.19.c.1

So according to this, I will submit with the 7th character P and see what happens! :)
 
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