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Active vs subsequent

Karen Posted Wed 28th of October, 2015 14:01:27 PM

Patient comes into office and the PA see patient and dx is S62.025A. The PA ordered a CT done and patient came back into office several days later and dx was a nonunion, S62.025K. Would the second visit be considered subsequent since a CT was done before appointment and the results were reviewed on second visit? Also patient was taken to surgery after the second visit for a nonunion repair, I assume that would have been subsequent or would he been active up until this point?

SuperCoder Answered Thu 29th of October, 2015 03:56:46 AM

It will be considered as subsequent visit. When it is clear that fracture is non-union and patient visiting the physician second time even CT has been performed earlier, still it will be considered as subsequent visit. ICD S62.025K is the appropriate code to bill for non-union fracture subsequent encounter.

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