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  ICD10 Watch
by Carl Natale

ICD-10 Terminology: Subsequent encounters with a common misunderstanding

I'm sorry if you already know this. But there are a lot of smart people who don't understand a fundamental term in the ICD-10 code set.

I found an example of it in an interview with Silvia Senes, an IT leader for more than 15 years who has tackled ICD-10 transition in Canada. She shared some valuable insights on ICD-10 implementation during the conversation.  But here's how it ended:

Before we close, you and I have joked before about some funny ICD-10 codes. Do you have a favorite one, if only because it's downright goofy?

W59.22XD - Struck by turtle, subsequent encounter

What are the odds of being struck by a turtle, not bitten, and of the encounter to happen more than once?

Yeah funny. My sides hurt (Please don't tell me the ICD-10 code for that.)

Patrick Zummo doesn't think the turtle jokes are very funny. And he tries to disarm turtles as weapons against ICD-10 specificity. Note that Senes doesn't use the turtle as a criticism. She just thinks its' funny. What's wrong with her joke is her understanding of "subsequent encounter." I will let Zummo explain:

"One of the biggest and most significant misconceptions inherent to the implementation of ICD-10 is the confusion that subsequent encounter means that ‘it happened again’. In truth, that designation is meant to describe when the patient has received active treatment for the injury, and the physician is providing routine care for the injury during the healing or recovery phase ("

Obviously Senes is an intelligent healthcare professional with experience working with ICD-10 code sets. But if she misunderstands a term used throughout the codes, there are plenty of other people doing the same.

Unfortunately they're using that misunderstanding to minimize the validity of the code set.


My take on this.... Initial

My take on this....

Initial treatment is generally while the patient is undergoing the first exam. These visits may occur in the ER, physicians office, or even surgical treatment.

Subsequent care is when the patient is done the initial "active" treatment, and receiving follow-up care. In the instance of orthopedics where a fracture has occurred and been treated. Cast changes, removal of internal or external fixation, medication or follow-up visits would all be subsequent to the initial encounter.

Sequela is when the patient is fully healed and returning for a complication of the initial condition. For example the patient had open reduction with internal fixation two years ago and now returns with a fascial hernia at the surgical site. That would be a sequela of the initial fracture.

For those of us coders out there, I think there are truly some odd ball ICD-10 codes that make no sense in relationship to these rules above.

W16.311D Fall into other water striking water surface causing drowning and submersion; subsequent encounter-This is where the book goes wrong. I see the new draft has added the words "submersion"; however the definition of drowning is death and you would not have a subsequent encounter for that ever!

T71.161D Asphyxiation due to hanging accidental; subsequent encounter. Again the general meaning of asphyxiation and hanging is death and one would not have a subsequent encounter.

I think this is where the detail in the book went awry. Of course people survive these accidents, but there are other codes that could be used with different wording.

Although I do not necessarily

Although I do not necessarily agree with the need for ALL of the codes that exist in ICD 10, I would argue that the above listed are, in fact, legitimate codes.
Drowning is defined as respiratory impairment from being in or under a liquid. It is further classified as by outcome into: death, ongoing health problems, etc, and does not necessarily result in death.
Asphyxiation is a condition of severely deficient supply of oxygen to the body that arises from abnormal breathing. Also further classified as by outcome into: death, ongoing health problems, etc, and does not always result in death.

Let me see if I can confuse

Let me see if I can confuse this issue even more. Is subsequent encounter from the reference of the patient or the particular provider who is providing service at that moment?

It would almost surely have

It would almost surely have to be from the viewpoint of the particular provider providing the subsequent service at the moment - or another provider who was somehow linked to the original service and had fore knowledge of the previous service/treatment - or would reasonably be expected to have such fore knownowledge.
There are a lot of reasons why it's important to link procedures within the "care/coverage period" associated with a particular indication and ICD-10's expanded coding scheme will facilitate that awareness.
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