Wiki Malunion Tibia

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cmacpc

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Need some help please. Have a case I am coding that is a six week old fracture patient was seen at an outside facility put in a short leg splint, but was unable to follow up with PCP for referral in the allotted time. Patient was finally referred to our facility and by this time he is diagnosed with a malunion fracture of the distal tibia. Doctor wants code 27827, I think it should be 27720, but what about the Dx what 7th character would be assigned?? Any opinions, thoughts would be greatly appreciated.

Thank you,
 
this is not the initial treatment for this fracture so the 27720 is the correct code. the 7th character is P for subsequent encounter with malunion.
 
I agree that this should be coded as 27720. Per CPT guidelines, if a specific code exists to identify nonunion/malunion repair of the fracture site being treated, then report that code. If there is not a code available for nonunion/malunion repair of a specific site, report the appropriate fracture treatment code with modifier 22.

However, I disagree with coding the 7th character P for subsequent encounter for malunion. I believe this should be coded as S82.30_A . Per ICD-10 guidelines, initial encounter 7th characters should also be assigned for a patient who delayed seeking treatment for the fracture including malunion or nonunion fractures.
 
The patient did not delay seeking initial treatment. He was initially treated in the ER, the initial treatment was a splint and a referral. That makes this subsequent treatment.
 
But thought that the seventh character A was for Active treatment for the condition? Does it state anything having to do with the provider, because he went to a total different facility before he came to our facility?
 
The patient completed the active treatment phase with the failure to pursue any follow up. The patient now returns after the allowable follow up time has expired for what ever reason pain or stiffness.. and wants it fixed the original acute fracture cannot be fixed as it has healed but with a malunion. It is for the patient a subsequent encounter due to the malunion. It would be different had the patient been injured and sought no treatment but weeks later presents with a malunion, then it would be the initial encounter to seek active treatment.
 
This was not active treatment though this was the patient’s subsequent treatment for a fracture that is now a malunion. The patient failed to follow thru with the original instructions so they decided they did not need anything further or whatever the reason was, the period for the completion of the original treatment passed when the patient decided not to follow thru. This now has to be subsequent treatment as the patient no longer has an acute fracture they have a malunion. If you use the A the treatment rendered will not match the status of the fracture. Also you will not be indicating correctly the patient diagnosis.
 
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