Help! ICD-10 Patella Fracture scenario

[lisa92]

S82.001(?)
A patient fractured her patella 1 year ago, never sought treatment. Saw our physician 6 months later for 1 visit and never came back. Patient comes back now seeking treatment. She now has a closed fracture of patella nonunion.
Would this be initial encounter (A), subsequent for closed fracture nonunion (K) or Sequela (S)? We have three coders with 3 different opinions.

 

[mitchellde]

Read the coding guidelines. They state that if the patient never sought treatment for a fracture that is not described as non union or malunion, you use the 7th character for initial since this is the patients initial encounter for active treatment.

 

[mitchellde]

It is not the K if the patient delayed seeking treatment. Per the coding guidelines as updated for 2015
Malunion/nonunion: The appropriate 7th character for initial should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion.

 

[mitchellde]

see that makes perfect sense to me-thank you...but what we are scratching our heads at is the proper dx code to use-how would one code for the initial encounter but as a nonunion fracture code since nonunion states subsequent encounter?

You use the fracture code with the A it is a fracture and it is the patients initial encounter for repair. You will not worry about the non union status since the payient delayed treatment.

 

[lisa92]

Thank you! That helps a lot!

 

[lisa92]

What if the patient did not delay treatment? Patient had a fracture was healing well, but now has a non union that requires surgery?

 

[mitchellde]

Then use the Subsequent with nonunion or with malunion depending on documentation.

 

[lisa92]

Great! Thanks

 

[debatortho]

Initial encounter/Non-union of fracture/No delay in treatment

This patient is new to this orthopedic surgeon but did not delay treatment and has a diagnosed non-union (scaphoid). How would this be coded?