E/M and ICD-10-CM for Fracture Patient Treated Prior to Physician Encounter

E/M and ICD-10-CM for Fracture Patient Treated Prior to Physician Encounter

March 19, 2020

Question:
I am looking forward to attending a 2020 KZA National Coding Course. I had schedule conflicts in 2019, but have been told these courses are a “must” for orthopaedic surgeons.

There was a patient with a hand fracture that was treated at a different hospital by another surgeon outside of my current practice. Pt chose to have follow-up care here with me. I have never seen this patient in the past and have never treated the current condition that was already treated with surgery. In this scenario would this patient and his condition consider be considered new and initial (I have never managed) or new and subsequent (already treated with surgery and follow up management)?

Answer:

Thanks for your comments and the Orthopaedic Team will look forward to meeting you at one of the courses. Please make sure you introduce yourself to the instructors. Your question has two parts:
1) E/M:
You will bill a new patient (9920x) if the patient has not been seen by any of your partners in the past three years; you will bill an established patient (9921x) if the patient was seen by one of your partners within the past three years.
2) Diagnosis:

Based on your description, because the patient has already entered the healing and recovery phase of care, you will use the appropriate 7th character for “subsequent encounter for fracture with routine healing”.

*This response is based on the best information available as of 03/19/20

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