Wiki Episode of care

[Lana1752]

I have a question regarding the episode of care. In a radiology practice, do we code as initial if this is the first time we have seen the patient or do we code as subsequent if patient was seen by their primary physician?

 

[mitchellde]

It depends on the injury not whether your provider is seeing the patient for the first time. If you are performing the X-ray to diagnose the fracture then it is initial as the injury has received no treatment yet. If you are checking the healing status of a fracture that has been treated then it is subsequent. If the patient has received no prior treatment and it is diagnoses as a malunion or nonunion of a fracture but the patient delayed in seeking treatment then it is considered initial. The dx codes are patient diagnosis codes not provider encounter codes. It has no bearing on whether you have treated the patient previously or not, it is based on the patient and the injury. The new 2015 guidelines do clarify this.