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encounters in ICD-10

  1. #1
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    Default encounters in ICD-10
    Medical Coding Books
    Is the encounter based per provider or per condition when determining ICD-10 code?
    For example if a patient was already treated by an ER physician for an injury and is then seen by his PCP...would the PCP code it as a subsequent encounter or is it considered initial since it is the initial encounter with the PCP?

  2. #2
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    The dx is the patient's so code the dx from that perspective.i

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
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    Default Thanks!
    OK...that makes sense! Do you have any documentation stating that? Did you find that in the ICD-10 guidelines? If so what section? I appreciate your help!

  4. #4
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    If you are referring to fracture coding, the Official Guidelines state that the initial encounter applies as long as the patient is receiving active treatment for the fracture, such as surgical treatment, an ED encounter, or eval and treatment by a new physician. Subsequent encounters would be used for encounters after the patient has completed active treatment listed above and is in the healing phase.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  5. #5
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    Quote Originally Posted by bpct6501 View Post
    If you are referring to fracture coding, the Official Guidelines state that the initial encounter applies as long as the patient is receiving active treatment for the fracture, such as surgical treatment, an ED encounter, or eval and treatment by a new physician. Subsequent encounters would be used for encounters after the patient has completed active treatment listed above and is in the healing phase.
    You are quoting from ICD-9 CM.
    ICD-10 CM is slightly different with the codes as there are extra digits to add to the fracture code to indicate subsequent episode so the ER is the initial and the next visit in the office is subsequent. Much like acute MI coding.
    However you are correct that if the fracture were not treated in the ER then it is still initial episode in the physician office.
    Last edited by mitchellde; 09-26-2011 at 12:36 PM.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
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    The Official Coding Guidelines for ICD-9 and ICD-10-CM are similar. The coding for traumatic fractures and how to use the extensions for initial encounter, subsequent encounter, and sequela are in Chapter 19, section a, which says what I typed above (from the 2011 guidelines). I didn't type it verbatim so it would definitely be a good reference, as obviously the guidelines are going to be when ICD-10-CM coding is being done Oct. 2013 and after.
    http://www.cdc.gov/nchs/data/icd9/10...2011_FINAL.pdf
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

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