Wiki Fracture Coding: Initial vs Subsequent

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khartoum1900nile@aol.com

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Billing question. I have a patient who's diagnosis is S32.9XXA for an Initial Fracture and is currently a patient at the Physical Therapy office. I found an article through AAPC (Fracture Diagnosis Coding: Initial Visit vs Subsequent Visit) stating that "Neither prescribing medicine, nor referral to a physical therapist, is considered active care for fracture coding". So, should S32.9XXS be assigned since the patient is only coming for PT? I want to have this clarified before I submit a query to the provider. The office has never dealt with the specifics of coding and billing and I am not strongly familiar with Fracture Coding. I don't want to bill this claim to insurance if the diagnosis code is incorrect. Thank you for your assistance.
 
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At the end of the day if you were to use the A at the end, it probably won't make a different. Is it correct? No. Most of the time, what you would see on this, if they are in routine healing, is the D at the end. Sometimes you might see the reason for the therapy, like weakness, stiffness, loss on function or some other type as the primary and the fracture w/ S as the secondary. But, the S (think late effect) is not really correct if they are still in the healing and recovery phase. The provider is probably just carrying over whatever dx was on the order or referral. You can also consider Z47.89 area too. Usually PTs will not use the fracture code with the A because that is not considered active treatment to restore the bone. It was already done by the ortho doc.
When ICD-10 started, I remember this was such a huge rigamarole. Everyone was all freaked out about it for therapy services. 😂

 
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