10-13-2017, 06:36 AM | Community Wiki

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Orthopedic Aftercare - When coding a follow-up

  1. Default
    Medical Coding Books
    what if the order says follow up to fracture but the xray does not show healing fracture. Do you use the aftercare code for this or is this still considered an active treatment since the xray does not show healing. One coder at my facility says that anytime pts see ortho drs after the first initial treatment of the fracture such as in er and then they see the ortho dr all of these should always being coded as aftercare not acute . i was taught it has to say healing fracture before you can use the aftercare codes. please help with this and explain and there is some confusion in my facility about active acute fracture vs aftercare fracture when they are not in the healing phase. thanks

  2. #12
    Columbia, MO
    The most important thing to remeber is that the diagnosis is the patient's not the payers. The payer can tell us what they cover and what they consider medically indicated but not what diagnosis code to use for a particular encounter. We cannot change a patient's diagnosis just because a payer says they do not accept V codes. They DO accept them, they may have a policy regard medical necessity that a V code does not meet. So no matter what you cannot use the acute fracture code after the initial treatment, you cannot use the acute degenerative joint code after a joint replacement. Rehab is a V code and is first only allowed and is required for rehab encounters whether they are inpatient or outpatient. We need to use the code that fits the patient regardless of whether it is a V code or not.
    I am not sure what you mean when you say the patient is not in the healing phase. If it is not documented as mal aligned or non healing then it must be healing. And there are other codes for mal aligned or non healing.

    Debra A. Mitchell, MSPH, CPC-H

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