Wiki A D S, 7th digits for ICD-10

[savanatrio]

Patient sees ER or even another doctor for , say, concussion. Then he comes to us, his PCP. This would be the first time WE have seen him for this concussion. Do we code this as an initial visit (A)? He may have been seen in ER but is it our job to research the patient to find out how many times he's been seen for a particular injury? What if he saw another doctor and didn't tell us? I cannot find ANYTHING about this in the book. I would call his first visit with US his initial visit for the concussion. A coworker thinks it should be subsequent (D) since he was seen before. Thoughts?

 

[mitchellde]

Patient sees ER or even another doctor for , say, concussion. Then he comes to us, his PCP. This would be the first time WE have seen him for this concussion. Do we code this as an initial visit (A)? He may have been seen in ER but is it our job to research the patient to find out how many times he's been seen for a particular injury? What if he saw another doctor and didn't tell us? I cannot find ANYTHING about this in the book. I would call his first visit with US his initial visit for the concussion. A coworker thinks it should be subsequent (D) since he was seen before. Thoughts?

The assignment of the 7th character for encounter is not based on whether this is your initial or subsequent encounter with the patient, rather it is whether this is encounter is the patient's initial encounter for active treatment by your provider or if this is a visit for aftercare which would be their subsequent. These are patient diagnosis codes so it is always from the patient perspective.
In addition, the guidelines were revised last year to include this clarification. It states that assignment of the 7th character is based on whether the patient is receiving active treatment and not whether the patient is seeing the provider for the first time. If the patient has been treated by another provider and you are providing no further active care for the injury then, even though you have never evaluated he patient or this problem, the visit is subsequent.