Wiki Cast Complication

[menakakamesh01]

Hi,

I have doubt regarding cast complication when a patient arrives hospital due to cast discomfort that created pain/ swelling/ in case too tight/loose after 2-3 days of closed reduction of radius fracture, what encounter do we use for the visit- initial or subsequent?
Can we apply the below concept? . please help

For complication codes, active treatment refers to treatment for thecondition described by the code, even though it may be related to an
earlier precipitating problem. For example, code T84.50XA, Infection and inflammatory reaction due to unspecified internal joint prosthesis,
initial encounter, is used when active treatment is provided for the infection, even though the condition relates to the prosthetic device,
implant or graft that was placed at a previous encounter.7th character “A”, initial encounter is used for each encounter where the
patient is receiving active treatment for the condition.


Kindly any one please convey your ideas. Thank you.

Regards,
Menaka.

 

[RyanRaichCPC]

Hello Menaka. That particular ICD10 code would not be appropriate for use in this scenario as it specifies complication due to internal prosthesis; A cast is not an internal prosthesis. It is common in Orthopaedics to have multiple cast changes throughout the global period due to discomfort, decrease in swelling, or even to take xrays verifying callous formation in the fractured bone. It would not be appropriate to bill for another office visit/E&M especially if the fracture was close reduced as the patient is now in 90 day global period. You could however, bill application of cast or splint with the use of modifier -58 and use the applicable ICD10 code for subsequent encounter of the fracture with routine healing if that applies. Yes, typically if you are still treating a patient you can continue to use 'initial encounter', however multiple ICD10 codes have specific 7th characters that are much more in depth such as fracture with delayed healing, nonunions etc., it truly depends on the guidelines and what injury occurred. If you have any more questions, I would be happy to help.

 

[menakakamesh01]

Hello Ryan,

Thank you so much for your reply.
We get controversy while coding when the patient arrives for bi valving the cast/ when the physician suggest pain medication/ just to check the cast without taking x-rays as it is too tight.

Regards,
Menaka