Wiki A, d, s

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graceroni13

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So my entire world just got turned upside down just a few minutes ago. I was under the understanding that initial was the first time you see a patient, subsequent is a followup for that problem, and sequela was if there were any "late effects" of that diagnosis. I work in an orthopedic office and this is how it worked in my head.... The patient is seen for knee pain, even though there isn't an A, D, or S for knee pain this would be the initial encounter. They're sent off for an MRI and they see a meniscus tear... that would be initial because it's a new problem. If they're seen one more time in the office then the doctor decides to do surgery, then that would be subsequent... then the surgery that would be initial because that's new treatment. Post-op (unless there are complications) would be subsequent, then if there are complications it would be sequela.

The nurse practitioner that i work with just gave me a print out from AANAC saying that the A would be for ALL active treatment. Again, if there was an a d s for OA for example.... she was saying that every visit until they have surgery would be initial. the surgery would be initial, and everything post op would be subsequent unless theres a complication which would be sequela. I keep hearing so many different things and it's driving me nuts :/ i think i understand the sequela thing, but it's when it's initial vs subsequent that seems to change... Another big confusion would be for revision surgeries as well for the A, D, S....

Can someone please help? I just want to make sure I understand this.
 
You should read the guidelines. These are not visit driven they are driven by the status of the injury. The guidelines were amended to clarify that initial is for when the patient is receiving active treatment and not whether you are seeing the patient for the first time. So it is initial for the active treatment and it can be initial for more than one encounter since active treatment can begin on one encounter and not be completed until the next encounter, such as a fracture requiring operative treatment but the patient is on anticoagulants, the surgery may be postpone ponied for a day or two.. Each visit is initial active treatment. Remember the diagnosis is the patients and these are patient diagnosis codes not provider encounter cides.
 
But the guidelines aren't specific to ortho, that's why I'm having such an issue with it. I just don't want to be saying everything is initial when it isn't. But from what I'm seeing, a meniscus tear would be initial until they have surgery... no matter how many times they're seen in office prior to surgery. That's my understanding from the article AND the guidelines but I would rather understand before I assume that I know what I'm doing
 
Chapter 19's guidelines have some useful info for Initial vs Subsequent encounters. Check out section c for Coding of Traumatic Fractures. It might help.
 
Thank you, I understand fractures, but it's the tears and stuff. I think I got it, but I'm definitely gonna be learning from denials haha. yay.
 
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