Tricky scenario from my doc (orthopedic surgeon) about when to use initial vs subsequent encounter. These are situations in which the injury goes from "active treatment" to "healing phase" and then back to "active treatment". Should the 7th character change back to "initial encounter" when, after monitoring the healing, the doc decides to do more active treatment?
Example 1: Patient comes in with right shoulder pain. Exam is indicative of shoulder impingement (726.10). Initially treated with therapy. Doesn't improve. Then I do an injection. Still has symptoms. Then I decide to do surgery.
Example 2: Patient comes in with a moderately displaced distal radius fracture. We do a closed reduction and apply a cast at the first visit. Second visit it still looks ok. Third visit, the alignment is not as good, and I recommend surgery.
Example 3: Patient comes in with a wrist injury. We diagnose a ligament tear. We treat with a splint. They improve but cannot tolerate work. We try therapy. Still some improvement, but not good enough. We then a wrist scope. Pain persists. We then do a second surgical procedure -- a wrist fusion.
Example 1: Patient comes in with right shoulder pain. Exam is indicative of shoulder impingement (726.10). Initially treated with therapy. Doesn't improve. Then I do an injection. Still has symptoms. Then I decide to do surgery.
Example 2: Patient comes in with a moderately displaced distal radius fracture. We do a closed reduction and apply a cast at the first visit. Second visit it still looks ok. Third visit, the alignment is not as good, and I recommend surgery.
Example 3: Patient comes in with a wrist injury. We diagnose a ligament tear. We treat with a splint. They improve but cannot tolerate work. We try therapy. Still some improvement, but not good enough. We then a wrist scope. Pain persists. We then do a second surgical procedure -- a wrist fusion.
