# Initial "A" vs "D" clafification Please



## bill2doc (Oct 22, 2015)

The more I read, the more I get confused.

Read this paragraph today on AAPC - ?Initial encounter utilizing ?A? for active treatment revised the examples in the guidelines to read:

Examples of active treatment are:  surgical treatment, emergency department encounter, and evaluation and continuing treatment by the same or different physician.? 

I've been using "A" for my docs initial visit then D for the follow up the next several days as he rounds.  Concussion S06.0X1A for first date of charges, then with the D for the next three days he rounds. but the above reads to me that because it's evaluation and continuing treatment by the same or different physician it's Still A ??? Please clarify if you will...ty


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## TheStephCode (Oct 22, 2015)

I stop and ask myself,...'has the healing process began?"  If not and treatment is still necessary and being sought then it continues to be initial,... if so then it is subsequent.  A perfect example of a multi visit initial encounter is a fracture seen in ER on a Sunday,.. then surgically set by Ortho on Monday.  The healing process does not begin until the ortho's surgical treatment, in this example, and that is when the healing process begins which is why it is also initial.


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## Sundancer (Oct 22, 2015)

*"A" doesn't necessarily = first!*

bill2doc....

Correct: "A" initial is NOT always synonymous to the first encounter only. It MAY apply to a second or even third encounter if ACTIVE treatment is happening. Initial=Active, not necessarily first. 

Where are you seeing the word "continuing"? Be careful not to add to the guidelines. I've read thru Chap 19 guidelines several times, and I haven't seen where it refers to it as "evaluation and continuing treatment..".  

See 19.a second and third paragraphs, and for fractures see 19.c.1 first and second paragraphs.  Read carefully, it should help clarify what is active and what is routine f/up care. (and I mean Read as in "red carefully" not "reed carefully" pronouncement sound!)

From 19.a  ".."A" initial encounter is used while pt is receiving active treatment....examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and treatment by a new physician. 
..."D" subsequent encounter is used...after the pt has received active treatment...and is receiving routine care for the condition during the healing or recovery phase. Examples of subsequent care are: cast change or removal, removal of external or internal fixation device, medication adjustment, other aftercare and follow up visits following treatment of the injury or condition."

I agree w TheStephCode's example, as I see these types of cases everyday in our group practice.  We have both an Urgent Care and medical group portion to our offices.  Many times our UC docs are treating someone w a possible fracture or injury and we are referring them out to ED or to Ortho. Or my MG docs might see a pt on f/up from the ED. 

If a pt was originally seen in the ED for an injury and then comes to one of my docs for followup care, and it's the first time we've seen and/or treated the injury, we're going to use the "A" extender.  Once the injury is then healing and we're seeing them in f/up, we'd use the "D" extender for routine followup care. 

On the flip, if a pt comes to one of our UC centers complaining of arm pain after playing football w friends and XR wet read shows a possible traumatic fracture, we're going to stabilize that fracture and refer them to Ortho for treatment and possible surgery. We would use the "A" extender for our encounter.  The Ortho is then going to evaluate and treat that pt by either setting the bone and casting (active trtmt), or possibly scheduling surgery (active trtmt).  The Ortho could potentially code the first two, or three, encounters they have w pt as "A" as well. The encounter for eval would be "A" and the surgery would be "A". 

A little longer and wordier than I meant, but I hope that helps!


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## mitchellde (Oct 22, 2015)

Sundancer said:


> bill2doc....
> 
> Correct: "A" initial is NOT always synonymous to the first encounter only. It MAY apply to a second or even third encounter if ACTIVE treatment is happening. Initial=Active, not necessarily first.
> 
> ...


You are correct in that A is not referencing the providers encounter with the patient, but rather whether the injury is receiving active treatment.  
However the wording for the continuing treatment by the same or different provider is correct.  This replaced the wording you referenced with the 2015 version of the guidelines.  
So the new wording under examples of active treatment does state continuing treatment by same or different provider.  and no longer states evaluation and treatment by new physician.  If you copy of the guidelines does not state this then you have the 2014 version and you will need to update to the 2015.


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## Sundancer (Oct 22, 2015)

Hi Debra, 

Okay, I thought you had me there, as I have both 2014 and 2015 books, and I _was_ looking in the 2014 on my desk (i like the layout better than the 2015's my office has). 

But....I looked in the 2015's and the wording is exactly the same in both the subsections..."eval and trtmt by new physician".  Nothing about continuing trtmt or same physician.  

How can that be?!?!?? The 2015 books are official AMA versions.  Purchased earlier this year.


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## Sundancer (Oct 22, 2015)

Sundancer said:


> Hi Debra,
> 
> Okay, I thought you had me there, as I have both 2014 and 2015 books, and I _was_ looking in the 2014 on my desk (i like the layout better than the 2015's my office has).
> 
> ...



Have there been additional revisions/additions, etc. since earlier in the year not aware of? I hadn't heard about any changes recently.


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## mitchellde (Oct 22, 2015)

If your 2015 book was published before the end of November 2015 then your publisher probably did not get the new 2015 guidelines in it.  But yes they were updated in November 2014.  The 2016 are the same as the 2015 at least so far. 
To get an updated copy you can go to
Http://www.cdc.gov/nchs/ICD.htm
When you get there go to ICD-10 CM scroll past the opening paragraph and look under 2016 and click on guidelines, it is a PDF file and will download nicely.


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## Sundancer (Oct 22, 2015)

mitchellde said:


> If your 2015 book was published before the end of November 2015 then your publisher probably did not get the new 2015 guidelines in it.  But yes they were updated in November 2014.  The 2016 are the same as the 2015 at least so far.
> To get an updated copy you can go to
> Http://www.cdc.gov/nchs/ICD.htm
> When you get there go to ICD-10 CM scroll past the opening paragraph and look under 2016 and click on guidelines, it is a PDF file and will download nicely.



Oohhh! there ya go! Well, they did make it a little clearer, eh? 

Thanks for the link! Printing several copies to give to the other coders in my office.  I think we got our 2015 books earlier this year, but sounds like we may have gotten edition before the updated guidelines  

All the more reason to go ahead and get a new 2016 book now.


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## bill2doc (Oct 23, 2015)

HUGE thanks to you both!!!


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