# Wound Care Initial or subsequent encounters?



## lorrib (May 25, 2016)

Hello,

I have a question regarding when an injury is considered initial or subsequent for a wound care clinic patient.  Our doctor sees patients for wound care and I know if they are being seen for the wound for the first time and doctor performs a debridement  then that is active wound care and should be coded with an A (initial visit) for the seventh character on the diagnosis.  I am unsure when to code for a subsequent (D) seventh character because the patients have numerous visits and multiple procedures on the same wound often with many visits in between procedures. I would assume that the encounters after the procedure should be coded with a D if he states that the wound is healing?  Can someone please advise on these type of situations?  What if the provider does not indicate if the wound is healing?  

Thanks,
Lorri


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## RebeccaC (May 26, 2016)

My understanding is that if the patient is in active treatment you would use he "A".  If they come in for a follow-up and active treatment is no longer being given (ie: follow-up to make sure wound is healing properly, etc.) that would be a "D".

Hope this helps!

Rebecca C, CPC, CPMA


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## mitchellde (May 26, 2016)

The fact a an encounter is the first one with your provider does not automatically make the 7th character an A.  Think of the A as meaning active treatment.  If this is active treatment of an injury that is still an acute injury and not in a healing state hen the 7th character is an A.  Like a burn that may need several sessions of devridement before it can begging healing, or a badly contaminated open wound that is not sutured due to the contamination.  Once the wound begins the healing process then you will use the D.  The A may be used for more than one encounter.  If the patient comes to your provider for wound aftercare and it is already in a healing state then even though it is your first encounter with the patient, the 7th character will be a D since patient is not receiving active treatment.


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## lorrib (May 27, 2016)

*Numerous treatments*

Hi Debra,

In this particular case, doctor does mention that the wound is healing (she was seen several times before and had a debridement); however the patient continues to come to the clinic and has had more visits (another debridement and a skin graft too) so I am confused.  The doctor does not indicate any complications or infection so I am assuming this is still in a healing phase.  Because the doctor mentions that the "wound is healing nicely" I want to assign a subsequent (D) character but the additional procedures are confusing me as to whether this is active wound care?  What are your thoughts on this?

Thanks,
Lorri


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## vaitheeswaranp (Jun 14, 2017)

*Wound Care*



lorrib said:


> Hi Debra,
> 
> In this particular case, doctor does mention that the wound is healing (she was seen several times before and had a debridement); however the patient continues to come to the clinic and has had more visits (another debridement and a skin graft too) so I am confused.  The doctor does not indicate any complications or infection so I am assuming this is still in a healing phase.  Because the doctor mentions that the "wound is healing nicely" I want to assign a subsequent (D) character but the additional procedures are confusing me as to whether this is active wound care?  What are your thoughts on this?
> 
> ...



Hi

You can code the wound with initial encounter when ever the active surgical treatment provided like ATT, SKIN GRAFTING etc..

Please find the below coding clinics examples as near references 




Admitted to Home Health Care for Routine Dressing Changes


      ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD-10 2015 Page: 37 Effective with discharges: November 13, 2015

Question:



The patient is admitted to home care for routine dressing changes and care for a healing postoperative wound infection that was previously treated during an acute care hospitalization. The patient is no longer receiving antibiotics for the infection. What is the appropriate 7th character for the wound infection code?



Answer:



Assign code T81.4xxD, Infection following a procedure, subsequent encounter-the 7th character is "D" because the patient is no longer receiving active treatment of the infection and is receiving routine care during the healing and recovery phase.



Outpatient physical therapy for wound care of burns


 ICD-10-CM/PCS Coding Clinic, Second Quarter ICD-10 2016 Page: 4 Effective with discharges: May 27, 2016 Related Information

A patient was referred to outpatient physical therapy ten days post discharge from the acute care hospital burn center. He had suffered third degree burns to both the right and left lower leg and thigh as a result of ignition of gas, which occurred while refueling his car. Physical therapy was providing wound care for the burn. What is the appropriate 7th character for the encounter for physical therapy? 



Answer:



Active wound treatment is active treatment. The primary reason for physical therapy is the burn injury, and the appropriate 7th character is "A" initial encounter. Assign codes T24.391A, Burn of third degree of multiple sites of right lower limb, except ankle and foot, initial encounter, and T24.392A, Burn of third degree of multiple sites of left lower limb, except ankle and foot, initial encounter. Code X04.XXA, Ignition of highly flammable material, should also be assigned to identify the external cause of the injury.





Encounter for wound check-up


      ICD-10-CM/PCS Coding Clinic, First Quarter ICD-10 2015 Pages: 6-7 Effective with discharges: March 16, 2015


Question:



The above patient returns three days later for a wound check with the pediatrician. The pediatrician only inspected the wounds. The wounds were found to be healing nicely, and no other intervention was required. The physician instructs the patient to return in six days for suture removal. Is "A" the appropriate 7th character, since this is a wound check, which is equivalent to aftercare, not active care? Should code Z48.817, Encounter for surgical aftercare following surgery on the skin and subcutaneous tissue be reported as the first-listed diagnosis?



Answer:



Assign code S01.02XD, Laceration with foreign body of scalp, subsequent encounter, as the first-listed diagnosis for the encounter at the pediatrician's office. Assign also codes S01.411D, Laceration without foreign body of right cheek and temporomandibular area, subsequent encounter; S01.21XD, Laceration without foreign body of nose, subsequent encounter; and V43.61XD, Car passenger injured in collision with sport utility vehicle in traffic accident, subsequent encounter, as additional diagnoses. In this case, the 7th character "D" subsequent encounter is appropriate, since the wound has already been treated and the current visit is for routine care during the healing phase of the injury. Per the Official Guidelines for Coding and Reporting, the aftercare Z codes should not be used for aftercare for conditions such as injuries or poisonings, where 7th characters are provided to identify subsequent care. Aftercare and follow-up visits following treatment of the injury are captured with the 7th character "D".

Hope This Helps

Thanks

Vaitheesh


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