Podiatry Coding & Billing Alert

Question: The podiatrist performed an MRI on a patient who had a displaced fracture of the base of his right second metatarsal. The patient was in the postoperative period for an open reduction internal fixation. Should I report Z47.89 along with the displaced fracture code?

California Subscriber

Answer: No. For the displaced fracture of the right second metatarsal, you would look to S92.321A (Displaced fracture of second metatarsal bone, right foot, initial encounter for closed fracture). But, you shouldn't include an aftercare code like Z47.89 when the primary code includes a seventh character.

For example, in this case, the seventh character explains that this patient is receiving initial treatment for the diagnosed fracture. Therefore, reporting Z47.89 (Encounter for other orthopedic aftercare) is redundant and unnecessary.

Some coders may argue that since this is technically a follow-up surgical visit, the seventh character should be D (Subsequent encounter). However, the postoperative state for the treatment of a fracture remains classified as part of the patient's initial encounter.

Official definition: ICD-10 defines subsequent encounters as "encounters after the patient has received active treatment of the injury and is receiving routine care for the injury during the healing or recovery phase." By this definition, the patient clearly would not qualify for the subsequent encounter seventh character. When the patient returns for a follow-up imaging to see the progress of the fracture's healing, you would code the fracture diagnosis with a D character (unless the fracture has not healed normally).