# Aftercare vs Follow up exam



## CJames72 (Jan 20, 2012)

I am a little confused about the use of follow up exam codes (V67).  I have seen two used; V67.4- f/u exam following tx of healed fracture and V67.09- f/u exam following other surgery.  At what point should the pt be switched from an aftercare code, ex V54.12, to V67.4?  If during that visit the notes state "pt's fracture has healed" shouldn't that visit still be coded as aftercare since the determination regarding the fracture being healed was made that day?  

In addition what are any additional guidelines re V67.09.  My understanding is this code would not be appropriate for post operative visits during the global period.  I would only apply this for possibly a yearly follow up.  Does anyone have additional information or sources regarding this code?

I appreciate any guidance.

Thank you.


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## cblack712 (Jan 20, 2012)

The best def I have ever seen is in the ICD9 book. For 2012 it is on pg 18 in the coding guidelines section. Basically, if the patient has been dx with a fracture and are in the docs office for that fracture- i.e to check the healing, change the cast, continued pain, removal of cast etc.. then you use the aftercare code. If the patient had a fracture a year ago and it has been considered healed and no longer receieving treatment for the fracture and they come in because the area is sore again you would use the follow-up.


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## ajs (Jan 20, 2012)

CJames72 said:


> I am a little confused about the use of follow up exam codes (V67).  I have seen two used; V67.4- f/u exam following tx of healed fracture and V67.09- f/u exam following other surgery.  At what point should the pt be switched from an aftercare code, ex V54.12, to V67.4?  If during that visit the notes state "pt's fracture has healed" shouldn't that visit still be coded as aftercare since the determination regarding the fracture being healed was made that day?
> 
> In addition what are any additional guidelines re V67.09.  My understanding is this code would not be appropriate for post operative visits during the global period.  I would only apply this for possibly a yearly follow up.  Does anyone have additional information or sources regarding this code?
> 
> ...



From the ICD-9 Guidelines pg 23.:
"Follow-up:
The follow up codes are used to explain continuing surveillance following completed treatment of a disease, condition, or injury.  They imply that the condition has been fully treated and no longer exists.  They should not be confused with aftercare codes that explain current treatment for a healing condition or it's sequelae.  Follow-up codes may be used in conjunction with history codes to provide the full pciture of the healed condition and its treatment.  The follow-up code is sequenced first, followed by the history code.

A follow-up code may be used to explain repeated visits.  Should a condition be found to have recurred on the follow-up visit, then the diagnosis code should be used in place of the follow-up code."


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## tefranklin57 (Jan 21, 2012)

Aftercare diagnosis codes are used during post-op period (10-90 days)
Follow up diagnosis codes are used after the post-op period
V67.09 or V67.59 is for a reckeck after the condition no longer exist (6months or a year later).


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## armen (Jan 21, 2012)

I personally use follow up dx after global period. Usually at this time all we charge is office visit & Xrays, (patient has no pain or other Dx) so the follow up is the best choice.


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