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initial or subsequent

Meredith Posted Thu 08th of October, 2015 15:12:07 PM

We have a patient who was seen in the ER by a different provider last week and was diagnosed with a clavicle fracture. Our provider saw this patient today, are we to code initial since it was her first time seeing the patient or subsequent since it was her second time being seen for the clavicle fracture?

SuperCoder Answered Mon 12th of October, 2015 01:43:24 AM

Thanks for your question.

If the patient is seeing in this facility first time, he/she is a new patient for this facility whether he was already seen for the same diagnosis in other facility previously, but both facilities should have different TAN no.

If the patient was seen by this facility in the last three years, he/she will be considered in established patient whether the diagnosis was different.
Hope this will help you

Meredith Posted Mon 12th of October, 2015 09:44:52 AM

I was in question about the diagnosis of the clavicle fracture, is it referring to and initial or subsequent fracture or and intial or subsequent treatment of the fracture?

SuperCoder Answered Tue 13th of October, 2015 01:37:47 AM


You will code this with initial encounter.

Guidelines state that a seventh character A is “used for the initial encounter for the injury or condition while the patient is receiving active treatment for the injury. Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and treatment by a new physician.

Here the condition applies "evaluation and treatment by a new physician."

The statement “evaluation and treatment by a new physician” can be a source of confusion. For example: The patient is evaluated in the emergency room (ER) for a displaced transverse fracture of the left ulna that cannot be managed at this time. The ER applies immobilization and ice and instructs the patient to follow up with orthopedics in the morning. This would be reported using S52.222A Displaced transverse fracture of the left ulna, initial encounter for closed fracture.

When the orthopedist rechecks the patient and reduces the fracture the later, the patient is receiving initial active treatment for this fracture. That is, this is the first encounter at which the patient receives definitive care (the ER was able to apply comfort care only). Per ICD-10 guidelines, you would again report S52.222A for an initial encounter.

Hope this will help you.

Meredith Posted Tue 13th of October, 2015 09:59:31 AM

Yes very helpful thank you!!

SuperCoder Answered Thu 15th of October, 2015 00:34:22 AM

Happy to help.

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