september 2015

Defining ICD-10 Encounters

There are three basic characters that are reported in the seventh character field that represent “Encounters” and they are A for initial, D for subsequent and S for sequela. Below we will define the type of encounter, the definition and how each character should be used.


A — Initial encounter — Active treatment (surgical treatment, emergency department encounter or evaluation and treatment by new physician) This is the most common 7th character extension that you will use in an ASC because it represents active or surgical treatment which is why the patient is at the ASC to start with – for surgical treatment.


D — Subsequent encounter — Routine care during healing or recovery phase (cast change/removal, removal of internal/external fixation device, medication adjustment, follow-up visits) Although this character represents a subsequent encounter do not confuse this with second visit or follow-up surgery. For example: a patient presents for the second in a series of three pain management injections. Even though this is the second visit for a subsequent injection, this is still an initial encounter because the patient is receiving active treatment for their primary diagnosis or condition. Look at the definition for subsequent encounter and for ASC coding we will be using the subsequent encounter character whenever the patient presents for removal of internal or external fixation related to previous fracture care. In these instances the physician must document what type of fracture was previously treated because the coder is required to use the ACUTE fracture diagnosis code with a seventh character extension of “D”. Again, the coder needs to recognize the previous treatment performed. Say for example that the patient’s previous treatment was for a bunion or hallux valgus repair and not a fracture and they present for removal of internal fixation. If that were the case then it would be appropriate to report diagnosis code Z47.2 Encounter for removal of internal fixation device.


S — Sequela — Late effect from initial injury Sequela is the late effect from an initial illness/injury which is defined as the residual effect ( or the condition produced) after the acute phase of an illness or injury has terminated. There is no time frame specified for when the late effect can occur. Note that the late effect has a direct correlation to the initial illness or injury, so if the patient had painful hardware that would be considered a complication but it is not a condition produced from the initial injury. An example of that would be when the patient had a previous articular fracture and then develops osteoarthritis in that joint due to the fracture. Coding for sequela usually requires two codes – the first being the nature of the sequela or in this case the osteoarthritis and then the sequela code which would be the acute fracture code with a seventh character extension of “S”.




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