Diagnosis for open fracture subsequent care

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The patient had an open fracture of the LT long finger distal phalanx with injury to the nail and LT ring finger distal phalanx from a table saw injury.
Initial encounter diagnoses: S62.633B, S62.635B, W31.2XXA
Subsequent encounter diagnoses: S62.633D, S62.635D, W31.2XXD alone? There are no codes that describe subsequent fracture care of an open fracture. If I try to code the finger lacerations with these (S61.313D, S61.215D), there's an excludes 1 note.
 

sls314

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Toledo, OH
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The patient had an open fracture of the LT long finger distal phalanx with injury to the nail and LT ring finger distal phalanx from a table saw injury.
Initial encounter diagnoses: S62.633B, S62.635B, W31.2XXA
Subsequent encounter diagnoses: S62.633D, S62.635D, W31.2XXD alone? There are no codes that describe subsequent fracture care of an open fracture. If I try to code the finger lacerations with these (S61.313D, S61.215D), there's an excludes 1 note.

Is the patient still in active treatment for the injury? If so, the initial encounter codes would still apply.

This is what the ICD-10 guidelines state about initial vs subsequent fracture care (I.C.19.C.1):

Initial vs. subsequent encounter for fractures


Traumatic fractures are coded using the appropriate 7th character for initial encounter (A, B, C) for each encounter where the patient is receiving active treatment for the fracture. The appropriate 7th character for initial encounter should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion.

Fractures are coded using the appropriate 7th character for subsequent care for encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase.
 
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