Wiki S82 A versus D

RaveenaS

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Hello! There seems to be a little confusion in my office about reporting S82 Fractures (trauma patients){We bill for the provider of General Surgery specialty, we are not part of the facility billing}. If a patient involved in an MVA comes in and fractures are reported, it is currently being coded with the 7th character 'A' when it's the first initial visit, let's say 02/20/22, initial observation is reported. The next day, General Surgery does an E/M visit, checking on the patient, does the Dx code 7th character change from 'A' to 'D' for now being a subsequent visit? The fractures were reported for the General Surgeon because they were addressed in the E/M visits, but General Surgery specifically did not fix/set the fractures, Emergency or Ortho may have been called and addressed the fractures for it be fixed. Appreciate any clarification on the use of these diagnosis 7th character for fractures (S82).
 
This is explained in the ICD-10 guidelines for Chapter 19, a. Application of 7th Characters in Chapter 19 and 19, c. Coding of Traumatic Fractures. There is also a decision tree. If people are confused print out the decision tree and follow it. It doesn't really have anything to do with the fact that it's a new vs. established patient or follow up. It has to do with if the patient is receiving "active" treatment for the injury or fracture or if they are in the healing/recovery phase. Then you also have the delayed healing, nonunion, malunion, etc. In the scenario you mention above it's probably not D on the rounding day because they are still admitted or in Obsv and receiving active treatment.
Separate the idea that it has to do with the visit type (new, established, etc.) from the seventh character (initial, subsequent), they are not the same concept.
 
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