Subsequent Encounters: Revisiting a common misconception in ICD-10 codes

Carl Natale
by Carl Natale

A couple weeks ago I wrote about what subsequent encounter means as written in the ICD-10 code set.

I quoted Patrick Zummo's analysis of turtle injuries and subsequent ecounters:

"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 ("

This week, Michelle Leppert explains how to code a certain coyote's encounter with a roadrunner. Which makes me believe a great way to teach ICD-10 coding would be to show some classic cartoons and figure out those diagnosis codes. I bet Elmer Fudd could find a use for the lamppost injury diagnosis codes.

But what happens when the coyote returns to the Acme Outpatient Clinic for a follow up visit?

"Actually, in this case we would use the exact same three codes, even the seventh character extension A. The seventh character A is for use as long as the patient is receiving active treatment for the fracture, according to the ICD-10-CM Official Guidelines. Active treatment includes:"

  • "Surgical treatment"
  • "Emergency department encounter"
  • "Evaluation and treatment by a new physician"

"Use the seventh character D for encounters after the patient has completed active treatment. Report the other seventh characters, listed under each subcategory in the Tabular List, for subsequent encounters for treatment of problems associated with the healing, such as malunions, nonunions, and sequelae."

According to Lippert, the seventh character A ("initial encounter") is used as long as the patient is seeking treatment for the initial injury. Even if that involves another physician.

I hope this helps.