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Alicia: Oh, another ICD-10, imagine that. This was a question that had come in, I believe,
in the forum.
Q: Torus fracture of upper end of right humerus, initial encounter (with Dr. A) for closed
fracture. That's the proper code for that S42.271A. Then, the patient comes back and
it's the same thing, subsequent encounter for fracture with delayed healing (with Dr.
A) the original doctor. So, the "A" at the end indicates initial encounter. The "G" on
the second code indicates this is a subsequent encounter and it has delayed healing. What's
so great is that you couldn't do that in ICD-9.
"Suppose the patient seeks out Dr. B at another practice to go to when they experience delayed
healing...would it still be coded S42.271G even though it was the initial visit for that
doctor?"
This is really, really interesting. When it came to the forum, I answered it and I think
I wrote some information about it. But then, when we put it on the slide, I really went
in to double check the guidelines and stuff. I kind of gathered what I had said, so I called
my fellow AAPC ICD-10 auditors just to confirm that what I was thinking was correct and she
agreed with me.
A: There's an excellent picture of that particular fracture which I went and found, which is
really awesome. Again, this is a really, really good question. You have to consider this is
a subsequent visit so the character G -- and they're called characters instead of digits
now because you have numbers and letters -- with a different physician because the character
is not referring to what is being done to the patient but the status of the diagnosis.
A different physician might be a consult or a 2nd opinion but the fact is the case diagnosis
had not changed.
So, think of it this way, this is a comparison I came up with in my little brain: If a person
takes an apple to another person and that person states that's a Red Delicious apple
(that's the diagnosis -- that is a Red Delicious apple). A day later comes back and asks and
is told it is now a Red Delicious apple that has been cut in half. That doesn't change
the fact that it's a Red Delicious apple. He goes to the second person and is told that
it's still a Red Delicious apple that has been cut in half.
So, the guy goes in, he's got a specific fracture of his humerus, the upper arm, and he goes
back a second visit and they've determined that it's not healing, it's slow to heal for
whatever reason and that has a specific code. But they're going to take that code with them
to another doctor.
If we scroll down the guidelines, I typed out the guidelines for this. Again, the A"
equals the initial visit. The "G" is a subsequent visit diagnosis with that also includes the
definition of slow to heal. The guideline states: 7th digit for initial encounters (A,
B, C. It only gives you a choice of A in the grouping that goes with it) 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.
Now, this is what threw me when I read the guideline because, "Oh! New physician," but
that's not what it means because the diagnosis is saying the same. If the new physician changes
the diagnosis, then it would be initial diagnosis. Does this make sense? You can't respond, sorry.
So, don't let a treatment by a new physician confuse you. You're not getting treatment
by a new physician, you're confirming that it's the same diagnosis and this is scenario
we were given. Now, if that doctor changes the diagnosis, then an "A" would be appended.
Let's say, he decides it's a pathological fracture or something, and therefore that's
what's not healing one, that would change everything. Then, it would be an "A" but the
diagnosis has been carried from one doctor to another so therefore it's a subsequent
visit.
So, you don't want to confuse the payer. If you want to put in "A" on that for the second
physician, then it would look as if to that payer that it was a re-fracture. OK? And you
don't want to paint the picture for the payer, and to do that you have to keep it as a "G"
unless the diagnosis changes. Now, that is different than it is for ICD-9 because we
didn't have these options in ICD-9 and we do now, so we can actually code with 10 to
a higher specificity and the continuous care is going to be better for the patient and
the all-around care for the patient is going to be better. OK? I think that's pretty much
all that was on the slide if we scroll down a little bit more, I think I said everything
else that was on there. Yeah! So, don't confuse the payer, think in terms of what you're telling
the payer, not necessarily what your thinking should be said, because it's not always the
same.