Wiki Help! ICD-10 Patella Fracture scenario

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lisa92

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