Wiki Initial vs subsequent - The pt was seen in the ER

[rjenn86]

The pt was seen in the ER with a displaced fx and was reduced in the ER. Referred to our office and now we are casting the patient. Would I code the fracture with an A or D?

 

[stephanie7480]

The pt was seen in the ER with a displaced fx and was reduced in the ER. Referred to our office and now we are casting the patient. Would I code the fracture with an A or D?

This is straight from the guidelines:

Initial vs. Subsequent Encounter for Fractures
Traumatic fractures are coded using the appropriate 7th character for initial encounter (A, B, C) while the patient is receiving active treatment for the fracture. Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and treatment by a new physician.

Hope this helps

 

[mitchellde]

This is straight from the guidelines:

Initial vs. Subsequent Encounter for Fractures
Traumatic fractures are coded using the appropriate 7th character for initial encounter (A, B, C) while the patient is receiving active treatment for the fracture. Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and treatment by a new physician.

Hope this helps

The guideline you reference has been replace for 2015. Initial is used only for the encounter(s) for active treatment
tApplication of 7th Characters in Chapter 19
Most categories in chapter 19 have a 7th character requirement for each applicable code. Most categories in this chapter have three 7th character values (with the exception of fractures): A, initial encounter, D, subsequent encounter and S, sequela. Categories for traumatic fractures have additional 7th character values. While the patient may be seen by a new or different provider over the course of treatment for an injury, 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.

The paragraph you reference is replaced with:

7th character ?A?, initial encounter is used while the patient is receiving active treatment for the condition. Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and continuing treatment by the same or a different physician
So in the example in the above post, if this is a replacement cast then it is subsequent. If a brace or splint is being replaced with a cast then it is subsequent. If no traction device was applied in the ER the it is initial.