In some cases, you may need to contact a referring provider for additional information. For that reason, ICD-10 contains a few options for coding for surgical aftercare. endstream
endobj
startxref
There are very few examples of reporting both a code for the acute illness and a code for the late effect at the same encounter, for the same patient. Marie Thomas, Topics: characters, fracture coding typically requires one of the following 7th characters; however, the ICD-10 tables or whatever tool you are using should specifically ask for one of these characters. Instead, ask the patient as many questions as possible to get to the root cause of the original injury. It is when the routine is interrupted with an infection, or dehiscence, or complication that causes the injury or condition to be readdressed that a true understanding of the seventh character assignment is required. A patient presenting to the point of care for the very first time to be examined and/or treated for a condition or injury that just occurred; assigning the seventh character A is a straightforward coding decision. If he or she is in the recovery phase of treatment, use D. So, when do you use this tricky sequela character? Otherwise, claims could be denied. Weve written an entire blog post on what to do prior to September 30 and after October 1, including specific to-dos for that 48-hour transition window. However, in many cases, the patient doesnt need active treatment after the first visit, such as a laceration that received stitches and the patient returns for suture removal or a fracture that gets treated by surgery or a cast/splint. Marie Thomas. If the patients primary diagnosis changes, and you need to update the plan of care, then you should update the diagnosis code. Our team is here to help. Many of them require a 7th character to identify the correct ICD10 code for the episode of care: initial, subsequent, or sequela. However, we wouldnt recommend using a cheat sheet, specifically. Fulfill every rehab therapy business need within one platform. That way, youre able to start with as clean of a slate as possible come October 1. Then, once October 1 hits, our system will automatically start recording ICD-10 codesrather than ICD-9on any finalized documentation. In nonunion, healing is also taking place, but there remains a gap between the bony structures at the fracture site. Thus, its imperative that you arrange the ICD-10 codes in order of importance, meaning that you should list the codes most relevant to the services provided first. ICD-10 will not affect functional limitation reporting (a.k.a. If you need to use the S 7th character, use both the injury/condition code that precipitated the sequela and the code for the sequela itself. You look at the instructions for the S44 code category and determine that you must add a seventh character to this code. (T81.33XA)(X50.0XXA)(Y93.89)(Y92.015)(Y99.8). We recommend checking out this ASHT page. sequela, Codes for bone, muscle, and joint conditions that are chronic or recurrentor that result from a healed injuryare typically found in chapter 13. Ask it in the comments below, and well get you an answer lickity split. The rules arent the same, and crosswalks typically yield unspecified ICD-10 equivalents. As expected, we received a lot of questions. 268 0 obj
<>stream
You choose S44.11, Injury of median nerve at upper arm level, right arm, for your patient. Do you feel brainy-buff enough we hosted the largest webinar in WebPT history, ICD-10 contains a few options for coding for surgical aftercare, https://www.webpt.com/blog/how-select-right-icd-10-code-pizza-ordering-speed, https://www.webpt.com/blog/pt-primer-coding-pain-and-injuries-icd-10, https://www.webpt.com/blog/medical-necessity-and-icd-10-what-physical-therapists-need-to-know. As this blog post details, there are three seventh characters related to the episode of care: This is huge: You do not always need to attach a seventh character to your diagnosis code. This code indicates visits where the injury/condition is diagnosed for the first time and has nothing to do with whether the provider has seen the patient in the past. Member Value Representative, Content Producer. PTM has one of the largest databases of outpatient PT/OT provider productivity, visit and payment information, with more than 5 million visits. We are understandably receiving a lot of questions regarding how and when to use the ICD-10 7, character is only required when the ICD-10 rules specifically ask for the 7, character and give you a choice as to which of several characters to use. Take for instance the 7th character assignment of injuries and conditions. Remote Therapeutic Monitoring by Physical and Occupational Therapists, North Carolina PT Board Position Statements March 2022. For additional info on dual coding, check out this post. Upon presentation to the provider, a decision was made to admit the patient to the hospital for debridement, washout, and closure of the wound dehiscence. Select the most specific code you can based on the information you have. Because the patient is receiving routine care for the injury in the healing and recovery phase, you determine that D is the appropriate seventh character. The ICD-1o 7th character is only required when the ICD-10 rules specifically ask for the 7th character and give you a choice as to which of several characters to use. 
If the patient is in the active phase of treatment, use A. Coding, The aftercare Z codes should not be used for aftercare of injuries/fractures where seventh characters are provided to identify subsequent care. More specifically, the following is an explanation of when each character is used. Dont. Stay on top of the latest rehab therapy tips, trends, and best practices with our weekly blog digest. As an alternative to these A, D and S 7th characters, fracture coding typically requires one of the following 7th characters; however, the ICD-10 tables or whatever tool you are using should specifically ask for one of these characters. Furthermore, once October 1 hits, we will allow for dual coding in cases involving non-HIPAA covered insurances, as the diagnosis code set will be tied to the insurance. You cant code for what you dont know; just make sure you communicate all the details in your documentation. 
This is not aftercare; this is a new problem impacting a previous injury. We recommend asking yourself the following questions regarding the patients injury: If its possible to submit external cause codes for a particular category or section of codes, you will see instructions to do so within the tabular list. So for billing purposes, youll only use your top four codes. You then add your seventh character of D, making the final diagnosis code: S44.11XD, Injury of median nerve at upper arm level, right arm, subsequent encounter. Then leave the seventh position blank, explains this blog post. intial, Imagine youre playing a game. If no multiple sites code is available, you should report multiple codes to indicate all of the different sites involved. Below are helpful reminders to ensure youre selecting the correct code for the patient visit. If youve used the Conversion Report to save ICD-10 codes to current patient cases, our system will automatically send those ICD-10 codes through to any notes finalized after the transition. subsequent, The first describes the condition or nature of the sequela(e), and the second describes the sequela(e) or late effect. If a late effect code describes all the relevant details, you should report that one code, only (e.g., I69.191Dysphagia following nontraumatic intracerebral hemorrhage). There is no time limit on when a sequela code can be used. If a patient has multiple diagnosis codes, which one should be the primary diagnosis? She has more than five years of experience in the rehab therapy technology space. T43.592D. Still have questions about Initial, Subsequent and Sequela ICD10 Codes? Just make sure you order the diagnosis codes you do submit in order of importance, with the primary diagnosis at the top. subsequent, Heres a quick clip to show you how to use external cause codes. Seventh characters are required for codes in certain ICD-10-CM categoriesprimarily Chapter 19 (Injury, poisoning and certain other consequences of external causes) and Chapter 15 (Pregnancy, childbirth and the puerperium). She has seven years of experience in content marketing and in the rehab therapy technology industry. In 2014, Medicare introduced a two-tier exceptions process. How to Use Z Codes in ICD-10, Request a Free Demo Until October 1, only ICD-9 codes can appear on claims submitted for reimbursement. The medical diagnosis is typically the one that comes with a referral patients script.
But if youve exhausted all options and still cant obtain the information necessary to select a more specific code, just make sure you clearly document the reasons behind your code selection within your documentation. You can use our ICD-9 to ICD-10 Conversion Report to begin saving ICD-10 codes to patient cases now. Adding a seventh character to a code that does not require one will make the entire code invalid., Weve seen multiple interpretations of what distinguishes an initial encounter from a subsequent encounter. Based on everything weve reviewed, this is the best answer weve found: The 7th character for initial encounter is not limited solely to the very first encounter for a new condition. D=Subsequent encounter which is for encounters after the patient has received active treatment for the injury/condition and is receiving routine care during the healing or recovery phase. A subsequent encounter uses the letter D and is used appropriately during the recovery phase, no matter how many times the patient has seen the provider for this problem previously. Seems simple doesnt it, and for injuries and conditions that follow the routine course of healing, coders should have no problem with this concept. For further insight on sequelae, check out this example from the AAPC: A patient suffers a low back injury that heals on its own. The seventh character didnt exist in ICD-9, so its caused a great deal of confusion. No worries. Furthermore, some state and regional payers may require the use of external cause codes, so check with each one individually. More specifically: an ICD-10 Rube Goldberg-style game. Youre in luck. And how should I order them? Heres the deal: the various seventh character options do not necessarily follow a set progression. It means ICD-10 is absolutely happening on October 1. The patient returning for follow up of the laceration or fracture during the healing stage would support the subsequent code. So, for the vast majority of PT/OT care requiring a 7th character, you should use D. S=Sequela which is when the patient is being treated for complications or conditions that arise as a direct result of a condition, such as recent pain due to an old injury or treatment of scar formation after a burn. (T43.212A, T43.592A, T39.312A (and the external cause codes)). You can find the ICD-10 diagnosis code search in the Quick Add, Add Patient, Patient Record, the Subjective section of evaluative notes, and within Daily notes. Examples include cast change or removal, medication adjustment, and other follow-up visits for treatment of the injury or condition. See how WebPT helps you over your biggest business hurdles. The HCFA form has already been updated for ICD-10. laceration of the right forearm following a chain saw accident in his yard, trimming his tree. All of us are vulnerable to being lulled into a false sense of coding satisfaction. Dont just take the physicians word as gospel. The most common 7th characters are A, D, and S. As a therapist, you almost always provide care during the healing or recovery phase of an injury and will therefore use the D character. =Initial encounter which is when the patient is receiving. When reporting sequela(e), youusuallywill need to report two codes. Embracing new coding concepts and guideline changes can sometimes overshadow established policies that we use daily, prompting a need to revisit. When a late effect occurs directly resultant from the previous injury or condition, the following seventh character should be assigned: Example: Chronic pain due to low back injury, (G89.21) chronic pain due to trauma (S39.002S) unspecified injury of muscle, fascia, and tendon of the lower back, sequela. For PT/OT, a 7th character is typically only required in the case of injuries. Or, if you are a WebPT Member, you can use the ICD-9 to ICD-10 Conversion Report to begin saving ICD-10 codes to current patient cases. A new treatment plan is developed, the patient is no longer in the healing phase, but rather is on a new initial phase. However, if you are treating a direct access patient who has not seen a physician or another provider first and you are providing active treatment for the injury, you would use the A 7th character for active treatment of the injury and generally the D character for follow-up visits during the healing/recovery phase. Your primary diagnosis code should be the one that most closely aligns with the reason the patient is seeking your services. It is following the patient throughout the treatment process that can be puzzling. Therapists will typically not use the A character because most of your patients have first been seen by a physician or other provider. Example: Patient is accepted to the Psychiatric Center follow treatment for an overdose with Advil, Trazodone, and lithium for evaluation and treatment of the major depressive disorder and post-traumatic stress disorder. There is no time limit on when a sequela code can be used. She has more than a decade of experience in marketing and sales with specialized knowledge in inbound and content marketing. Headquarters3201 Enterprise Pkwy. The ICD10 guidelines dont specify when active treatment becomes routine care. This is a clinical decision by the provider and is based on the patients course of treatment. Most of the PT-relevant codes that allow for external cause codes are located in Chapter 19 of the tabular list (which you can access here). In some categories and families of codes, there is no bilateral option for denoting laterality. So, it appears that the words initial and subsequent have less to do with how many practitioners the patient has already seen or how many visits the patient has logged at your office, and more to do with the patients treatment phase (i.e., A for active treatment and D for recovery/healing). S (sequela) indicates a complication or condition that arises as a direct result of an injury. We actually sell one in the WebPT Marketplace, so if youre a Member, you can purchase it at a discounted price here. Stay current on all things rehab therapy. Example: Patient is admitted for acute care treatment for overdose of Advil, trazodone, lithium. While chiropractic physicians will primarily use the chronic and recurrent musculoskeletal conditions from Chapter 13, Diseases of the Musculoskeletal System and Connective Tissue, there are several relevant codes from Chapter 19. CMS 1500 forms were updated in 2013 to accommodate ICD-10, so you shouldnt have any problems there. Copyright 2022 ICD10monitor. However, if the patient is simply making progress, you can document his or her progress as normal. 245 0 obj
<>/Filter/FlateDecode/ID[<053546DEC0157149A122587A158437BF>]/Index[223 46]/Info 222 0 R/Length 107/Prev 122985/Root 224 0 R/Size 269/Type/XRef/W[1 3 1]>>stream
Want all this ICD-10 goodnessand morein a downloadable doc? As a provider of comprehensive healthcare support services that include medical coding, medical billing, and healthcare revenue cycle consulting, our goal is to live up to our name by crafting business partnerships that work brilliantly in a symbiotic nature. From there, you should order the codes according to importance and significance regarding medical necessity. The treatment diagnosis is the one that represents the injury or condition that you, as the therapist, are treating. A sequela is the residual effect (produced by the condition) after the acute phase of the injury has ended. It may involve multiple episodes of care for fracture/injury or complications of medical/surgical care, and it may involve more than one physician treating the patient. Marie Thomas holds a Masters in Healthcare Administration from Pfeiffer University, Charlotte, NC, and a Bachelor of Science in Healthcare Administration from Pfeiffer University. One thing that helps me is to ask myself this question: If the answer is no, then you have no question that the seventh character is A initial. A sequela code is for complications or conditions that arise as a direct result of a condition or injury. Then, once October 1 hits, our system will automatically start sending ICD-10 codesrather than ICD-9through to your finalized notes. That said, you can begin using our Conversion Report to save ICD-10 codes to patient charts for those patients who likely will span the transition. So, if youre using CPT codes, ICD-10 will not change that. As this post explains, If you add a seventh character to a code with fewer than six characters, you must fill each empty slot with a placeholder X. For example: No, you would only change the seventh character if the patient progressed to a different phase of treatment (i.e., the patient moved from the active treatment phase to the recovery/healing phase). intial, They include acute musculoskeletal conditions such as sprains and strains of the spine, codes that will be used frequently by chiropractors. It also applies to visits by any provider during the active treatment of the injury/condition. To learn more about selecting diagnosis codes that help justify treatment, check out this blog post. For a patient seeking treatment for multiple conditions involving multiple body parts, you would create separate cases just as you do with ICD-9. Dont see the answer to your burning ICD-10 question? endstream
endobj
224 0 obj
<. ICD-10 does have a set of procedure codes, but anyone who currently uses CPT codes to designate procedures will continue to do so. All Rights Reserved.
If the patient is in the active phase of treatment, use A. Coding, The aftercare Z codes should not be used for aftercare of injuries/fractures where seventh characters are provided to identify subsequent care. More specifically, the following is an explanation of when each character is used. Dont. Stay on top of the latest rehab therapy tips, trends, and best practices with our weekly blog digest. As an alternative to these A, D and S 7th characters, fracture coding typically requires one of the following 7th characters; however, the ICD-10 tables or whatever tool you are using should specifically ask for one of these characters. Furthermore, once October 1 hits, we will allow for dual coding in cases involving non-HIPAA covered insurances, as the diagnosis code set will be tied to the insurance. You cant code for what you dont know; just make sure you communicate all the details in your documentation. This is not aftercare; this is a new problem impacting a previous injury. We recommend asking yourself the following questions regarding the patients injury: If its possible to submit external cause codes for a particular category or section of codes, you will see instructions to do so within the tabular list. So for billing purposes, youll only use your top four codes. You then add your seventh character of D, making the final diagnosis code: S44.11XD, Injury of median nerve at upper arm level, right arm, subsequent encounter. Then leave the seventh position blank, explains this blog post. intial, Imagine youre playing a game. If no multiple sites code is available, you should report multiple codes to indicate all of the different sites involved. Below are helpful reminders to ensure youre selecting the correct code for the patient visit. If youve used the Conversion Report to save ICD-10 codes to current patient cases, our system will automatically send those ICD-10 codes through to any notes finalized after the transition. subsequent, The first describes the condition or nature of the sequela(e), and the second describes the sequela(e) or late effect. If a late effect code describes all the relevant details, you should report that one code, only (e.g., I69.191Dysphagia following nontraumatic intracerebral hemorrhage). There is no time limit on when a sequela code can be used. If a patient has multiple diagnosis codes, which one should be the primary diagnosis? She has more than five years of experience in the rehab therapy technology space. T43.592D. Still have questions about Initial, Subsequent and Sequela ICD10 Codes? Just make sure you order the diagnosis codes you do submit in order of importance, with the primary diagnosis at the top. subsequent, Heres a quick clip to show you how to use external cause codes. Seventh characters are required for codes in certain ICD-10-CM categoriesprimarily Chapter 19 (Injury, poisoning and certain other consequences of external causes) and Chapter 15 (Pregnancy, childbirth and the puerperium). She has seven years of experience in content marketing and in the rehab therapy technology industry. In 2014, Medicare introduced a two-tier exceptions process. How to Use Z Codes in ICD-10, Request a Free Demo Until October 1, only ICD-9 codes can appear on claims submitted for reimbursement. The medical diagnosis is typically the one that comes with a referral patients script.
But if youve exhausted all options and still cant obtain the information necessary to select a more specific code, just make sure you clearly document the reasons behind your code selection within your documentation. You can use our ICD-9 to ICD-10 Conversion Report to begin saving ICD-10 codes to patient cases now. Adding a seventh character to a code that does not require one will make the entire code invalid., Weve seen multiple interpretations of what distinguishes an initial encounter from a subsequent encounter. Based on everything weve reviewed, this is the best answer weve found: The 7th character for initial encounter is not limited solely to the very first encounter for a new condition. D=Subsequent encounter which is for encounters after the patient has received active treatment for the injury/condition and is receiving routine care during the healing or recovery phase. A subsequent encounter uses the letter D and is used appropriately during the recovery phase, no matter how many times the patient has seen the provider for this problem previously. Seems simple doesnt it, and for injuries and conditions that follow the routine course of healing, coders should have no problem with this concept. For further insight on sequelae, check out this example from the AAPC: A patient suffers a low back injury that heals on its own. The seventh character didnt exist in ICD-9, so its caused a great deal of confusion. No worries. Furthermore, some state and regional payers may require the use of external cause codes, so check with each one individually. More specifically: an ICD-10 Rube Goldberg-style game. Youre in luck. And how should I order them? Heres the deal: the various seventh character options do not necessarily follow a set progression. It means ICD-10 is absolutely happening on October 1. The patient returning for follow up of the laceration or fracture during the healing stage would support the subsequent code. So, for the vast majority of PT/OT care requiring a 7th character, you should use D. S=Sequela which is when the patient is being treated for complications or conditions that arise as a direct result of a condition, such as recent pain due to an old injury or treatment of scar formation after a burn. (T43.212A, T43.592A, T39.312A (and the external cause codes)). You can find the ICD-10 diagnosis code search in the Quick Add, Add Patient, Patient Record, the Subjective section of evaluative notes, and within Daily notes. Examples include cast change or removal, medication adjustment, and other follow-up visits for treatment of the injury or condition. See how WebPT helps you over your biggest business hurdles. The HCFA form has already been updated for ICD-10. laceration of the right forearm following a chain saw accident in his yard, trimming his tree. All of us are vulnerable to being lulled into a false sense of coding satisfaction. Dont just take the physicians word as gospel. The most common 7th characters are A, D, and S. As a therapist, you almost always provide care during the healing or recovery phase of an injury and will therefore use the D character. =Initial encounter which is when the patient is receiving. When reporting sequela(e), youusuallywill need to report two codes. Embracing new coding concepts and guideline changes can sometimes overshadow established policies that we use daily, prompting a need to revisit. When a late effect occurs directly resultant from the previous injury or condition, the following seventh character should be assigned: Example: Chronic pain due to low back injury, (G89.21) chronic pain due to trauma (S39.002S) unspecified injury of muscle, fascia, and tendon of the lower back, sequela. For PT/OT, a 7th character is typically only required in the case of injuries. Or, if you are a WebPT Member, you can use the ICD-9 to ICD-10 Conversion Report to begin saving ICD-10 codes to current patient cases. A new treatment plan is developed, the patient is no longer in the healing phase, but rather is on a new initial phase. However, if you are treating a direct access patient who has not seen a physician or another provider first and you are providing active treatment for the injury, you would use the A 7th character for active treatment of the injury and generally the D character for follow-up visits during the healing/recovery phase. Your primary diagnosis code should be the one that most closely aligns with the reason the patient is seeking your services. It is following the patient throughout the treatment process that can be puzzling. Therapists will typically not use the A character because most of your patients have first been seen by a physician or other provider. Example: Patient is accepted to the Psychiatric Center follow treatment for an overdose with Advil, Trazodone, and lithium for evaluation and treatment of the major depressive disorder and post-traumatic stress disorder. There is no time limit on when a sequela code can be used. She has more than a decade of experience in marketing and sales with specialized knowledge in inbound and content marketing. Headquarters3201 Enterprise Pkwy. The ICD10 guidelines dont specify when active treatment becomes routine care. This is a clinical decision by the provider and is based on the patients course of treatment. Most of the PT-relevant codes that allow for external cause codes are located in Chapter 19 of the tabular list (which you can access here). In some categories and families of codes, there is no bilateral option for denoting laterality. So, it appears that the words initial and subsequent have less to do with how many practitioners the patient has already seen or how many visits the patient has logged at your office, and more to do with the patients treatment phase (i.e., A for active treatment and D for recovery/healing). S (sequela) indicates a complication or condition that arises as a direct result of an injury. We actually sell one in the WebPT Marketplace, so if youre a Member, you can purchase it at a discounted price here. Stay current on all things rehab therapy. Example: Patient is admitted for acute care treatment for overdose of Advil, trazodone, lithium. While chiropractic physicians will primarily use the chronic and recurrent musculoskeletal conditions from Chapter 13, Diseases of the Musculoskeletal System and Connective Tissue, there are several relevant codes from Chapter 19. CMS 1500 forms were updated in 2013 to accommodate ICD-10, so you shouldnt have any problems there. Copyright 2022 ICD10monitor. However, if the patient is simply making progress, you can document his or her progress as normal. 245 0 obj
<>/Filter/FlateDecode/ID[<053546DEC0157149A122587A158437BF>]/Index[223 46]/Info 222 0 R/Length 107/Prev 122985/Root 224 0 R/Size 269/Type/XRef/W[1 3 1]>>stream
Want all this ICD-10 goodnessand morein a downloadable doc? As a provider of comprehensive healthcare support services that include medical coding, medical billing, and healthcare revenue cycle consulting, our goal is to live up to our name by crafting business partnerships that work brilliantly in a symbiotic nature. From there, you should order the codes according to importance and significance regarding medical necessity. The treatment diagnosis is the one that represents the injury or condition that you, as the therapist, are treating. A sequela is the residual effect (produced by the condition) after the acute phase of the injury has ended. It may involve multiple episodes of care for fracture/injury or complications of medical/surgical care, and it may involve more than one physician treating the patient. Marie Thomas holds a Masters in Healthcare Administration from Pfeiffer University, Charlotte, NC, and a Bachelor of Science in Healthcare Administration from Pfeiffer University. One thing that helps me is to ask myself this question: If the answer is no, then you have no question that the seventh character is A initial. A sequela code is for complications or conditions that arise as a direct result of a condition or injury. Then, once October 1 hits, our system will automatically start sending ICD-10 codesrather than ICD-9through to your finalized notes. That said, you can begin using our Conversion Report to save ICD-10 codes to patient charts for those patients who likely will span the transition. So, if youre using CPT codes, ICD-10 will not change that. As this post explains, If you add a seventh character to a code with fewer than six characters, you must fill each empty slot with a placeholder X. For example: No, you would only change the seventh character if the patient progressed to a different phase of treatment (i.e., the patient moved from the active treatment phase to the recovery/healing phase). intial, They include acute musculoskeletal conditions such as sprains and strains of the spine, codes that will be used frequently by chiropractors. It also applies to visits by any provider during the active treatment of the injury/condition. To learn more about selecting diagnosis codes that help justify treatment, check out this blog post. For a patient seeking treatment for multiple conditions involving multiple body parts, you would create separate cases just as you do with ICD-9. Dont see the answer to your burning ICD-10 question? endstream
endobj
224 0 obj
<. ICD-10 does have a set of procedure codes, but anyone who currently uses CPT codes to designate procedures will continue to do so. All Rights Reserved.