Wiki INJURY, INITIAL ENCOUNTER

[rleif1sun]

patient presents to PCP following ED visit for foot injury. PCP first time seeing this patient for this injury but no active treatment done. is diagnosis code billed by PCP as foot injury initial encounter or subsequent?

 

[carlystur]

I believe the determination is where the injury is being actively treated at whichever encounter is the initial encounter. Don't trust my words, though.

 

[thranowski]

patient presents to PCP following ED visit for foot injury. PCP first time seeing this patient for this injury but no active treatment done. is diagnosis code billed by PCP as foot injury initial encounter or subsequent?

When a new provider sees the patient for the first time, we always bill initial, even if they aren't altering the plan of care from the ED or specialist they might have seen first. They're still actively treating the patient for the first time even if it's just to review and approve the plan of care, so we apply initial.

For every other visit, we apply subsequent. If another provider in our office sees the patient for the first time for the same problem, we still apply subsequent since we're in the same office. We have not had any issues with payment coding this way.

I believe the determination is where the injury is being actively treated at whichever encounter is the initial encounter. Don't trust my words, though.

It's within an office. If your provider is separate from the ED, then when your provider is seeing them for the first time, it would be considered initial. If one provider in the office saw them first, they would bill initial, and if another provider in the same office saw the patient for a follow up, they would bill subsequent.

 

[dtricia]

I have an article from HealthCare Business Monthly on this topic. it says per the ICD10 definition of 'initial' this for the initial encounter for the injury or condition while the patient is receiving active treatment for the injury: surgical treatment, casting, splinting. If patient is evaluated in the ER for a fracture and it is only immobilized, iced then follow up with Ortho next day, this is initial for ER and Ortho. However if in the ER the patient has a fracture that is casted, sees PCP next day, it would be initial for ER, subsequent for the PCP. We are to view the encounters from the perspective of the patient-was active treatment received.