Wiki A (initial) vs D (subseqent) on injuries-one more question

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AR2728

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When a patient presents and is first simply diagnosed as sprain but, due to continued pain at future visit(s) is sent for a MRI. The MRI then reveals a fracture, not simply sprain. At this point, would I now code the fracture with an A as well since this is the initial visit directed at the true fracture or D since this injury was treated previously but was believed to be a sprain? Does it matter if the course of treatment doesn't change? In some cases, they were previously placed in walker boot for sprain and will remain in a walker boot for fracture.

Please give me your thoughts and insight. I struggled with this as, like many, was informed multiple times that a new physician automatically means use an A. Although this didn't make sense in cases such as, suture removal for a healed laceration when ER placed sutures-this is not active treatment-the wound is healed.
 
The guidelines state specifically, if the PATIENT delayed in treatment of a fracture and then presents with a non Union or malunion you would use the initial encounter. This patient presented appropriately and was misdiagnosed. therefore active treatment for the injury had already been rendered. Even if it was not the correct treatment. So I would code this encounter as subsequent.
 
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