October 2, 2014
Our practice sees a fair number of patients with a diagnosis of “open wounds”. I was looking at these codes in ICD-10 and noticed a character needs to be added to say whether the encounter is initial or subsequent. Is the first visit with the doctor always A for initial and the follow up visits always D for subsequent?
When first reading the descriptions associated with the 7th character extensions A and D, it would appear that initial encounter is the first visit and all others visits are subsequent, but this is NOT the case. Initial and subsequent encounters are determined on whether the condition is being actively treated (A) or if the condition is in the healing or recovery phase (D). For otolaryngology, the codes that require 7th character extensions are injuries (e.g., fractures, superficial and open wounds and foreign bodies).
Examples of initial encounter –
A: surgical care, emergency department, evaluation and treatment by a new physician
Examples of subsequent encounters –
D: cast change, medication adjustment, removal of internal or external fixation devices
It will be possible for multiple claims to be submitted with diagnosis codes that have initial encounter for the same condition. If a patient presents to the clinic with a foreign body of the nose, the diagnosis code for the visit would be T17.1XXA (Foreign body in nostril, initial encounter). The foreign body was not able to be removed in the office and required surgical treatment. When the patient has surgery, the diagnosis code would be T17.1XXA (Foreign body in nostril, initial encounter) because the foreign body is still being actively treated. If the patient follows up after the foreign body has been removed, the diagnosis code would be T17.1XXD (Foreign body in nostril, subsequent encounter) because the active phase of treatment is over and the patient is in the healing phase.