# sequela or subsequent



## MAWK (Jan 11, 2016)

I am really confused thought I had the initial sequela and subsequent down but not so sure now.  This patient came into our facility for follow up on foot injury.  Provider documented the patients presents today with right foot pain.  Seen at a different facility for the initial treatment has a follow up appointment at a later date with them.  The provider documented this visit as a sequela visit.  I am thinking it is a subsequent visit. Which would it be.


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## Bjacobs0691 (Jan 11, 2016)

*Sequela or Subsequent*

Was this the second time the pt was seen at your location? And is she returning because of the injury or is it another foot? If she was seen there and is returning because of pain from the injury to her foot then that would be a sequela and not a subsequent visit. Subsequent would be for the next follow she has for her foot. 

Hope this helps!!


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## MAWK (Jan 11, 2016)

this is the first time here her initial was at a different facility.


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## mitchellde (Jan 11, 2016)

If this is a follow up visit for the healing injury, then this visit is subsequent. If this is a visit for residual pain after the injury has healed, then this visit is for pain as sequela from the injury.


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## bengles (Jan 11, 2016)

*Response*

If you are seeing this patient as a F/U to foot surgery, and the patient is having an onset of pain in the same foot, then you will bill for a sequela; even tho this is the first time your doc has seen the patient.


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## Bjacobs0691 (Jan 13, 2016)

I'm sorry I probably read it wrong, your doc is confusing you by saying its a follow-up from her visit with the other facility. This should just be an initial visit because your doc has never seen her before and you said its not the same practice correct? If it is the same practice though, but a different doctor than it would be a sequela. But if its the first time your doc is seeing her in that facility PERIOD then its just initial. you guys don't have anything to do with her other visit.


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## avon4117 (Jan 13, 2016)

Bjacobs0691 said:


> I'm sorry I probably read it wrong, your doc is confusing you by saying its a follow-up from her visit with the other facility. This should just be an initial visit because your doc has never seen her before and you said its not the same practice correct? If it is the same practice though, but a different doctor than it would be a sequela. But if its the first time your doc is seeing her in that facility PERIOD then its just initial. you guys don't have anything to do with her other visit.



exactly


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## mitchellde (Jan 13, 2016)

Read your guidelines!  Initial is to be used for active treatment of the injury and necessarily for the first time being seen by the provider.  If the injury has already been treated then the follow up is coded as subsequent regardless of whether it is a new patient or established.  Or whether you have previously evaluated this injury Or the first time for the injury.  Sequela is for residual or late effects after the injury had healed.


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## Bjacobs0691 (Jan 13, 2016)

mitchellde said:


> Read your guidelines!  Initial is to be used for active treatment of the injury and necessarily for the first time being seen by the provider.  If the injury has already been treated then the follow up is coded as subsequent regardless of whether it is a new patient or established.  Or whether you have previously evaluated this injury Or the first time for the injury.  Sequela is for residual or late effects after the injury had healed.



What happens if a patient comes in and doesn't mention that they were seen before? I'll reread but if this is the first time in a new place why would that fall under a subsequent visit. I'm just thinking logically but I mean I could be wrong if guidelines say different.


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## mitchellde (Jan 13, 2016)

The provider should be able to tell if an injury has received professional treatment.  Also these codes are the patient's diagnosis not the provider encounter. The 7th characters are denoting the status of the injury. Or in other words which encounter is this for the patient injury.  It does not matter that it is your providers first encounter, but is this the pTient's initial encounter for active treatment.  If active treatment has already been rendered, say in the ER, then this encounter with your provider is the patient's subsequent encounter for follow up of the injury.  It all depends on what is being done.  If the ER could not complete or accomplish active treatment and the patient was referred to your provider then your provider would render active treatment and it woul be an A.


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## MAWK (Jan 14, 2016)

thank you all for your comments it really helps.


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