# Cast Change?



## elizabeth24 (Oct 27, 2015)

Any ideas on what diagnosis code to assign for a patient presenting to ER for a cast change after getting water on the cast? 
I was looking at either _admission for change of wound dressing _(Z48.01), but I wasn't sure that a "cast" would be considered a wound dressing.
I was also looking at the diagnosis code for _admission for fitting and adjustment of orthopedic device_ (Z46.89).

Anyone have any suggestions?

Thanks!

Beth


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## hayatchaalan (Oct 27, 2015)

I would code to the fracture/injury then with the 7th character as a D, that is how we do it in the clinic setting not sure if the same rules apply to the ER.


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## elizabeth24 (Oct 27, 2015)

I wondered about that too, but the physician did not give many details on the fracture, and it was treated and surgically fixed at another facility, but I felt like that was more appropriate as well. 

Thanks


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## mitchellde (Oct 27, 2015)

If this is just a cast change and the fracture is healing as expected the if the initial injury was a closed fracture it is the fracture code with a D.  This is covered in the guidelines.  You do not use after care Z code for injury and trauma, you will use the appropriate injury code with the correct 7th character.  Also cast changes are an example of subsequent care.  It does not matter the setting of the encounter.


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## elizabeth24 (Oct 27, 2015)

That is initially what I thought as well, but I wasn't 100% sure. Thanks so much!


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