you cannot use both the acute fx code and the aftercare code, if the fx has already been managed and the patient is here for a follow up for the fixation device then it is most appropriate to use the the V58.43 followed by the V54.09.. If you will see the note with the V58.4 category that states codes from this subcategory should be used in conjunction with other aftercare codes to fully identify the reason for the aftercare encounter.
The patient no longer has an acute fracture as it is now set in position so this is not an encounter for an acute fx it is an aftercare encounter.
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