# Coding a suture removal



## Sarahmk (Sep 1, 2016)

Patient was seen for suture removal.  The issue is the diagnosis code to be used for the site the sutures were removed from.  Patient had an ankle fracture 6 months ago.  Patient recently had surgery to remove hardware from ankle by orthopedist.  He came to us, his primary doctor, for removal of sutures.  What diagnosis code do I use for this?  I don't think ankle pain would suffice, do I code laceration - but this wasn't technically a laceration.  Can I code aftercare for fracture?  Help!


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## CodingKing (Sep 1, 2016)

Z48.02 - Encounter for removal of sutures


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## mitchellde (Sep 1, 2016)

Per coding guidelines, you will not use Z codes for aftercare for injury or trauma, you use the trauma code with the subsequent 7th character.  so if the original injury was an open fracture then you use that code , if the injury was a closed fracture, you use that code with the 7th character indicating subsequent encounter.


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## amyhamilton (Jun 27, 2017)

mitchellde said:


> Per coding guidelines, you will not use Z codes for aftercare for injury or trauma, you use the trauma code with the subsequent 7th character.  so if the original injury was an open fracture then you use that code , if the injury was a closed fracture, you use that code with the 7th character indicating subsequent encounter.



Disagree. Guidelines state "An external cause code may be used with any code in the range of A00.0-T88.9, Z00-Z99, classification that is a health condition due to an external cause." Code the Z4802 with the injury with subsequent code.


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## mitchellde (Jun 27, 2017)

the guidelines state that you do not use aftercare Z codes for injury and trauma, you use the injury code with the appropriate 7Th character for subsequent encounter.  I did not state to use an external cause code I stated that you use the trauma code for the fracture with the 7th character for subsequent encounter. Z48.02 is an aftercare code and as such is not to be used for aftercare for a fracture.


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## Michele Price (Jul 12, 2017)

*Seventh Character?*



mitchellde said:


> the guidelines state that you do not use aftercare Z codes for injury and trauma, you use the injury code with the appropriate 7Th character for subsequent encounter.  I did not state to use an external cause code I stated that you use the trauma code for the fracture with the 7th character for subsequent encounter. Z48.02 is an aftercare code and as such is not to be used for aftercare for a fracture.



I have a question on the 7th character code. If the patient is a new patient and the they are being seen for suture removal, what is the 7th character. This is where I get confused?

Thanks for your help!


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## daedolos (Jul 12, 2017)

New patients always get the A designation as long as they are correctly defined as new.

Peace
@_*
If a doctor in your office saw the patient prior in perhaps a hospital session, then the followup visit at the office would be a 7th letter D designation.


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## thomas7331 (Jul 13, 2017)

daedolos said:


> New patients always get the A designation as long as they are correctly defined as new.
> 
> Peace
> @_*
> If a doctor in your office saw the patient prior in perhaps a hospital session, then the followup visit at the office would be a 7th letter D designation.



This is incorrect information - the 7th character designation has nothing to do with whether or not the patient is new to the provider.  Per the ICD-10 guidelines, A is 'used while the patient is receiving active treatment for the condition'; D is 'used for encounters after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase.  

Assuming your patient's sutures are from the procedure performed to repair this injury and removal of the sutures is part of the routine follow-up care, then this patient would be in the recovery phase and 7th character D would be most appropriate for this encounter.


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## daedolos (Jul 14, 2017)

Thomas, if a patient shows up with a referral from his PCP for a fractured finger and makes his first visit to a specialist, the injury code would be 7th letter A on the encounter form for the specialist.

Peace
@_*
Please advise.


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## stephanieannec (Jul 15, 2017)

I think it depends on whether or not the treatment is completed for the patient's fracture. We don't have enough information in the example provided to make an absolute determination. If the hardware was added for fixation and the fracture is healed and the hardware is removed according to documentation, wouldn't that be the status code for removal of sutures? If the patient isn't otherwise being treated for the fracture by the PCP i.e. with an x-ray or prescribing pain meds, or doing a physical examination of the affected limb, I'd hesitate to use a diagnosis code in this setting.

If, according to documentation, the fracture is still healing, then you'd probably want to use D with the fracture code. I think it would be unlikely that the patient would be referred to a PCP for suture removal when the patient still requires ACTIVE TREATMENT, i.e., needs a new cast, the patient is in extreme pain and needs fixation and pain meds, right after completing surgery weeks after injury, but I think there could plausibly for the sake of argument be a scenario where an A would be acceptable as well, such as the patient going to a new orthopedist for active treatment right after surgery.

It's a pretty big deal to my knowledge for the same practitioner/medical group/tax id to use the A code more than once. I have never heard of new practitioners getting flagged for using an A code ... yet.


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