Wiki Fracture Coding Status

[BSHWES]

Our coding department is having trouble interrupting the ICD-10 Coding of Pathalogical Fractures. The Paragraph states" the 7th charachter A is used for use as long as the patient is receiving active treatment for the fracture. " The confusing statement is " assignment of the 7th character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time."

Here is our Scenario 1 - We need to know if this instance would be coded with an A or a D

Patient has a broken tibia - the fracture is reduced at the hospital by physician from our practice. Two days later the patient is seen in the physicians office for follow up of the reduction.

Since the patient saw the same physician at both the hospital and the office will the DX code be for active care or subsequent care when seen in the office.

Scenario 2:
Patient has the same injury as above, but the fracture is reduced by the ER physician - he is then referred to a physician in our practice. Since the care will be follow-up, but the initial time our physician sees the fracture do we follow code an A or D

Any help with clarification on this matter is appreciated.

 

[mitchellde]

Our coding department is having trouble interrupting the ICD-10 Coding of Pathalogical Fractures. The Paragraph states" the 7th charachter A is used for use as long as the patient is receiving active treatment for the fracture. " The confusing statement is " assignment of the 7th character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time."

Here is our Scenario 1 - We need to know if this instance would be coded with an A or a D

Patient has a broken tibia - the fracture is reduced at the hospital by physician from our practice. Two days later the patient is seen in the physicians office for follow up of the reduction.

Since the patient saw the same physician at both the hospital and the office will the DX code be for active care or subsequent care when seen in the office.

Scenario 2:
Patient has the same injury as above, but the fracture is reduced by the ER physician - he is then referred to a physician in our practice. Since the care will be follow-up, but the initial time our physician sees the fracture do we follow code an A or D

Any help with clarification on this matter is appreciated.

The DX is based on the status from the patient perspective since it is the patient diagnosis. So
Scenario one
It is initial in the ER and subsequent in the physician office
Scenario 2
It is initial in the ER and subsequent in the physician office.
It does not matter who provides the initial active treatment once the fx has received the definitive treatment the rest of the encounters go to subsequent or sequela.
If the ER was unable to treat the fx and applied comfort and temporary treatment, then sent them to your provider for definitive treatment, then it will be initial n the ER and initial n the provider office.