Initial vs Subsequent in Hospital setting

patti66

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I'm very confused when to use initial vs subsequent when a patient is in the hospital-- do we only use A for fist initial visit then switch to D for remainder of stay, or do we use A for entire time frame of hospitalization as we're "actively" treating a fracture etc?
 

charlna

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Yes I would use "A" for the entire initial hospitalization.
 

mitchellde

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Remember ICD-10CM codes are for the patient's diagnosis not the physians encounter. Therefore from the perspective of physician coding, you use the initial character when the patient is undergoing initial Active treatment for the injury, such as the surgery or the reduction. Once that has been accomplished the rest of the encounters with the provider are subsequent so use the subsequent character for the healing phase.
So for a patient that presents to the ER and is evaluated with a fracture that will require going to the OR . The evaluation is part of the active treatment so use the initial character. So say the patient is unable to go to the OR due to some other health issue and so the fracture is immobilized and the patient is sent to the inpatient unit. Each day the patient is checked and evaluated is part of the active treatment so use the initial character. The day the patient is taken to the OR is also the active treatment so use the initial character. However for the encounters after the fracture has been treated in the OR, from the perspective of the patient the active treatment has been completed and the injury moves into the healing stage. Therefor all encounters after definitive treatment are now subsequent encounters.
 
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wilccm

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Question regarding presenting problem

When a patient is admitted for a new problem do we count that as a new problem for the entire stay.
 
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