Wiki Coding traumatic fractures

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mtatman

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When does the 7th digit for Intitial vs Subsequent change if you see a patient with an orbital fracture and no treatment is done at visit 1 but you want to monitor the injury in two days and then a week etc.? When would it change from A to B or would it if no actual treatment other than an office visit it required for monitoring the injury to see if anything changes? Thanks in advance to anyone who can help! :)
 
This is an example from CMS about how long you can use the active 7th character for a fracture:

Let?s take a look at an injury example. This patient presents to the emergency department with a dislocation of the posterior acromioclavicular joint in the left shoulder. If you look up the term ?Dislocation, shoulder? in the alphabetic index, the sub-entry for ?acromioclavicular? refers you to the index entry ?Dislocation, acromioclavicular,? where a sub-entry for ?posterior? references S43.15. A dash to the right of this code in the index entry indicates that additional characters are needed to complete this code. When S43.15 is looked up in the Tabular List, an instructional note indicates that codes in this category require a 7th character to identify whether it?s an initial or subsequent encounter, or sequela. When you look up S43.15 in the Tabular List, you will see that S43.152A, Posterior dislocation of left acromioclavicular joint, initial encounter, is the correct code. The next few examples show how to select the appropriate 7th character for type of encounter by following the same patient with the dislocated shoulder through different encounters for various phases of treatment and recovery for this injury. This patient is seen for further evaluation of his injury by an orthopedic surgeon after being referred by the emergency department physician. It is the same code, including the same 7th character for initial encounter, as the emergency department visit because it is still considered active treatment for the injury. The same patient undergoes surgical repair of the injury. Again it is the same code, as it is still considered an initial encounter because the patient is still receiving active treatment.

http://www.cms.gov/Outreach-and-Edu...nloads/2014-12-01-ICD-10-Video-Transcript.pdf

But I?m thinking if your patient comes in with an orbital fracture and the Dr. prescribes steroids and other meds that will be your initial encounter.
If he comes back and it?s all better and the MD doesn?t admit him for surgery, then you?re going to use your routine healing code:

Code: S023XXD
Description: Fracture of orbital floor, subs for fx w routn heal

Hope this helps.
 
It is initial while the payient is receiving active treatment. If the fracture is one that does not typicall recieve aggressive active treatment for repair, meaning no worse, bars , plates, casts, pins, etc. then the initial Eva
To determine that the fracture is best left as is and just monitor the patient then the next visit to continue to monitor the patient for healing is subsequent. If the payient cannot be aggressively treated at the first encounter due to things like the patient is on anticoagulants, then the fracture will remain initial until the patients fracture is treated.
See the difference is the first case it was decided at the outset that no additional treatment was necessary as the fracture would satisfactorily heal on its own with no active intervention. In the second case it is planned from the beginning that intervention will happen but the patient us unable to have this performed for a couple of days.
 
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