Question INITIAL VS SUBSEQUENT

bharathiT

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Patient treated with splint for fracture(S82.831A) and refer him to ortho care in urgent care.

In ortho care, the physician evaluvate and said that contiune the splint for 3 weeks.

The diagnosis state that closed fracture with routine healing.

What is ICD ?

S82.831A OR S82.831D
 

bharathiT

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Ok thanks. if the diagnosis not mentioned as routine healing means, The ICD consider as subsequent or initial?
 

bharathiT

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As per ICD guidelines, 7thcharacter “A”, initial encounter is usedfor each encounter where thepatient is receiving active treatment for the condition.

In this scenario, patient still in active treatment , so in this case why not initial encounter?
 

Munzueta

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You have to be careful with the difference between A and D.
First thing you want to know, A - Initial encounter, is not "first time visit," the best keyword to remember "A" is "active treatment" so the way I like to think basically for most cases, is hospital setting for A.
D - Subsequent encounter is used for when patient has completed active treatment of the condition and is now receiving routine care, keyword I like to apply here for "D" is "follow up."

So for instance, lets say I broke my right arm right now, I go to the hospital today, they do surgery to fix it, it will be coded as "A" since I am receiving active treatment of my injury. The doctor will have me do a follow up in 2 weeks to make sure is healing properly. I go to my appointment in 2 weeks with my PCP to check on my injury and is healing well, so character "D" comes in now. If I re-break my same exact arm/bone and go to the hospital again for surgery, it will be once again a "A" case, and not a "D" case.

So just remember, "initial encounter" doesn't mean first, and "subsequent" doesn't mean second, you have to read carefully the guidelines, most of the outpatient follow-up cases for injuries are coded to "D" and there are also other 7th characters besides A,D,S that will specify that its a subsequent encounter but the injury is not healing properly (nonunion or malunion).

Hope this helps!
 

mitchellde

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As per ICD guidelines, 7thcharacter “A”, initial encounter is usedfor each encounter where thepatient is receiving active treatment for the condition.

In this scenario, patient still in active treatment , so in this case why not initial encounter?
In your scenario the ortho provider did not provide any active treatment, you stated he evaluated the patient and said to continue the splint, this is subsequent treatment. If the ortho had removed the splint and performed a manipulation and reduction of the fracture and then casted or splinted again that would be additional active treatment and it would be coded with the A.
 
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