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Ankle Sprain Acute ICD-9? Late Effect?

Kirsten Posted Wed 22nd of July, 2015 16:16:14 PM

The patient had an accidental fall on 5/19/15 and sprained her ankle. She first came to the orthopedists' office on 6-19-15. She was diagnosed with an acute ankle fracture with an ICD-9 code of 845.09. She was advised to begin physical therapy for this. The patient was non-compliant. She now returns 2 weeks later for a follow up with persistent ankle pain. At her subsequent visit, would the ICD-9 code still be 845.09? Or is it now considered a "late effect" code of 905.7? At what point does a an acute injury become chronic? At what point does the diagnosis change from acute to chronic? At what point does the diagnosis change from acute to late effect? Thanks for your assistance.

SuperCoder Answered Thu 23rd of July, 2015 03:49:03 AM

ICD 845.09 is not for ankle fracture, it is for ankle sprain. Well, for second visit you can code ICD-9-CM 719.47 (ankle pain) as primary diagnosis. For "acute" and "chronic" conditions codes are specifically divided, it is not clinically defined in coding concept, means if it is mentioned in the medical record as "Acute/Chronic" then only specific code should be given. Late effect code will not to be given here as late effect code is sequenced second-
For eg: due to a spinal cord injury patient has paraplegia.
Code 1st 344.1 Paraplegia (current problem) and code 2nd 907.2 Late Effect of Spinal Cord injury (late effect code or cause of the problem).
Hope it helps!

Kirsten Posted Thu 23rd of July, 2015 09:07:27 AM

According to the ICD-9 book, a late effect is the residual effect after the acute phase has terminated. What point does this acute phase end? 90 days? It is not well defined when an injury goes from acute to chronic. I have worked for physicians in the past that will use an "8" code for a diagnosis when the injury happened sometime during the Korean War. I know that we can use a "V" code for subsequent encounters for follow up fracture care. Is there a "V" code that we can use when a patient returns for follow up of a sprained ankle? She is still having pain. Is there any other code we can use other than 719.47? Would you still use 845.09? Just code the symptoms? What about V54.9? Is her pain considered a late effect of her sprain? I am really looking for a timeline. The medical record is very non
specific concerning acute/chronic. I know there is not a global period because there is no surgery. Because we still treating her sprain, is it still an "8" code? Symptoms only? Please help.

SuperCoder Answered Fri 24th of July, 2015 10:20:00 AM

Well, I understand this is little confusing because clinical and coding concepts are different in respect to some aspects. So, first let’s try to understand what the different acute and chronic- acute phase, which is subdivided in two stages- early acute phase (2-48 hours) and subacute phase (2 days to 2 weeks), after this there is intermediate and chronic phase which continues throughout the lifetime of the patient if condition persists. And as far as late effect is concern, a condition that appears after the acute phase of an earlier, causal condition has run its course. A late effect can be caused directly by the earlier condition, or indirectly by the treatment for the earlier condition. For example- deformity of ankle mortise after the fracture of lower end of tibia, here deformity is late effect. For example- deformity of ankle mortise after the fracture of lower end of tibia, here deformity is late effect. Whereas some late effects can occur decades later. In your case if you are still treating ankle sprain, then append the code for it only, because pain is not the late effect here. Need not to give V code as well. Hope it helps!

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