# displaced vs. non displaced



## OOSMCcoding (Aug 25, 2015)

Patient seen in the ER and displaced fx was reduced.

Told to contact our office, so this is patient's initial visit to us.

The question is now that it is no longer displaced, do we code it as a non displaced fx or displaced, going with the original diagnosis?

Displaced fx's that have been reduced, do often re-displace.  It might seem odd to code our initial visit as a non displaced fx...only to have it displace again and then we are back to a displaced dx...which the patient initially received tx for in the ER.

I'd like confirmation it should be a displaced dx at the pt initial visit to us.

Thank you


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## mitchellde (Aug 25, 2015)

If you are coding ICD-9 you will use the V54 code for healing fracture.  In ICD-10 CM you will use the same code for what was originally diagnosed if repaired then the visit to your provider will be subsequent not initial.
Read the guidelines as updated for 2015.  Initial does not represent the first encounter with your provider.  If the fx has been reduced and the patient is following up with your provider then it will be subsequent.


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## OOSMCcoding (Aug 26, 2015)

Thank you for your prompt reply Debra.

We have read the guidelines and also attended a two day boot camp thru AAPC, just last month.  We went over this scenario and it was determined this scenario would be an initial encounter for us... as we would fall under new physician evaluation.  Our provider would be evaluating the patient for the first time....the fracture could have displaced again.

I don't mean to dispute what you are saying, but we went over this..   Is this just our instructors interpretation?  Are there any other interpretations on this site or is everyone of the same understanding?

Thank you again for your help.


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## mitchellde (Aug 26, 2015)

This is just your instructors interpretation.  This was clarified in the guidelines for 2015.  Under the Chapter 19 guidelines part a it states:
While the patient maybe see by a new or different provider over the course of treatment for the injury, assignment of the 7th characteris based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time .
If the fracture was treated prior to coming to your office then it is a subsequent encounter for the patient for treatment of the injury.  These are patient codes not provider encounter codes.  If the fracture displaces again then it would be subsequent with a nonunion 7th character.


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## OOSMCcoding (Aug 26, 2015)

We still could have interpreted this as an initial visit.  I think the statement could have been made more clear using "with" instead of "and".      
"While pt may be seen by new or different provider over the course of tx...assignment of 7th character is based on...active tx."
EXAMPLES of active tx are: sx, ed, and eval "with" (not and) continuing tx"
So if the pt is seen for eval for the same condition without tx...then it is subsequent.  We have a grasp on it now....correct?  
Thank you


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## mitchellde (Aug 26, 2015)

Mostly.  However if the displaced fracture received initial treatment and you are providing the subsequent care and the fracture displaces again this would not be initial again it would be subsequent with non Union.  They did change the examples of initial to read "continuing treatment by the same or different provider", (the word evaluation has been removed, the word new has been removed). Which means continued active treatment.  You will be initial if the patient received only comfort treatment and they send the patient to your provider to definitively treat the fracture.  For the ER to provide immobilizations and comfort is a start of treatment, for your provider to then provide the manipulation, reduction and traction device is a continuation of the active treatment.


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## OOSMCcoding (Aug 27, 2015)

Great, understood.  

Apparently, I am unable to find the latest, latest guideline on line.  I have the version that still contains evaluation in the verbiage.

Thank you for your clarification!


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