Contact with other nonpowered hand tool, initial encounter. W27.8XXA is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2018/2019 edition of ICD-10-CM W27.8XXA became effective on October 1, 2018.
Per ICD-10 guidelines, you would again report S52.222A for an initial encounter. ICD-10-CM defines subsequent encounters as “encounters after the patient has received active treatment of the injury and is receiving routine care for the injury during the healing or recovery phase.
ICD-10-CM introduces a third concept, sequelae, which applies to conditions that occur after subsequent treatment and after the acute phase of a disease or injury.. The ICD-10-CM Official Guidelines define the initial encounter diagnosis coding as the one to use "while the patient is receiving active treatment for the condition."
Assign code T81.4xxD, Infection following a procedure, subsequent encounter-the 7th character is "D" because the patient is no longer receiving active treatment of the infection and is receiving routine care during the healing and recovery phase.
Aftercare codes are found in categories Z42-Z49 and Z51. Aftercare is one of the 16 types of Z-codes covered in the 2012 ICD-10-CM Official Guidelines and Reporting.
ICD-10 code Z71. 89 for Other specified counseling is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
ICD-10 Code for Other specified postprocedural states- Z98. 89- Codify by AAPC. Factors influencing health status and contact with health services. Persons with potential health hazards related to family and personal history and certain conditions influencing health status.
Activity codes are found in category Y93. They are used to describe the patient's activity at the time of the injury. External cause status codes are found in category Y99.
ICD-10 code Z51. 81 for Encounter for therapeutic drug level monitoring is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
The patient's primary diagnostic code is the most important. Assuming the patient's primary diagnostic code is Z76. 89, look in the list below to see which MDC's "Assignment of Diagnosis Codes" is first.
10 for Atherosclerotic heart disease of native coronary artery without angina pectoris is a medical classification as listed by WHO under the range - Diseases of the circulatory system .
85.
ICD-10 code R10. 9 for Unspecified abdominal pain is a medical classification as listed by WHO under the range - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified .
Y99. 9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Y99.
An external cause status code should be assigned whenever an external cause code is assigned. Only one status code may be reported at the initial encounter and, just like the Activity and Place of Occurrence codes, Y99. 9 Unspecified External Cause status should not be reported if it is not stated within the record.
External cause codes are used to report injuries, poisonings, and other external causes. (They are also valid for diseases that have an external source and health conditions such as a heart attack that occurred while exercising.)
Z03. 89 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z03.
Having a high amount of body fat (body mass index [bmi] of 30 or more). Having a high amount of body fat. A person is considered obese if they have a body mass index (bmi) of 30 or more.
Encounter for screening for other diseases and disorders Screening is the testing for disease or disease precursors in asymptomatic individuals so that early detection and treatment can be provided for those who test positive for the disease.
121, Z00. 129, Z00. 00, Z00. 01 “Prophylactic” diagnosis codes are considered Preventive.
The ICD-10-CM Official Guidelines define the initial encounter diagnosis coding as the one to use "while the patient is receiving active treatment for the condition." It goes on to say that this could be for surgical treatment, an emergency department encounter, or evaluation and treatment by a new physician.
When the patient is treated in the emergency room, the doctor would code T24.032A for the burn of unspecified degree of the left lower leg, T31.0 because the burns occupied less than 10 percent of the body surface, and X12.XXXA for contact with other hot fluids.
If the patient needed to have a surgical intervention to treat the burns, the A would continue to be used as the seventh character for the surgery because the burn would be considered to be under active treatment.
An initial encounter is denoted in ICD-10-CM by the seventh character of A.
Scott Kraft, CPC, CPMA ( skraft@drsmgmt.com ). The author is an Auditor and Consultant at DoctorsManagement.
If the patient is treated in the emergency room for comfort care, then follows up with another physician as an outpatient for active treatment, that second physician will continue to use the A for active encounter. The code selections would be the same.
Most practices are reporting that ICD-10 claims have been accepted without incident, while others are seeing claims rejected for a variety of reasons. As this issue of The Business of Medicine went to press, only a handful of practices submitted ICD-10 claims quickly enough to have seen them paid.
Contact with nonvenomous toads, subsequent encounter 1 V00-Y99#N#2021 ICD-10-CM Range V00-Y99#N#External causes of morbidity#N#Note#N#This chapter permits the classification of environmental events and circumstances as the cause of injury, and other adverse effects. Where a code from this section is applicable, it is intended that it shall be used secondary to a code from another chapter of the Classification indicating the nature of the condition. Most often, the condition will be classifiable to Chapter 19, Injury, poisoning and certain other consequences of external causes ( S00-T88 ). Other conditions that may be stated to be due to external causes are classified in Chapters I to XVIII. For these conditions, codes from Chapter 20 should be used to provide additional information as to the cause of the condition.#N#External causes of morbidity 2 W50-W64#N#2021 ICD-10-CM Range W50-W64#N#Exposure to animate mechanical forces#N#Type 1 Excludes#N#Toxic effect of contact with venomous animals and plants ( T63.-)#N#Exposure to animate mechanical forces 3 W62#N#ICD-10-CM Diagnosis Code W62#N#Contact with nonvenomous amphibians#N#2016 2017 2018 2019 2020 2021 Non-Billable/Non-Specific Code#N#Type 1 Excludes#N#contact with venomous amphibians ( T63.81- R63.83)#N#Contact with nonvenomous amphibians
W62.1XXD describes the circumstance causing an injury, not the nature of the injury.
ICD-10-CM says the seventh character S is “for use for complications or conditions that arise as a direct result of an injury, such as scar formation after a burn. The scars are sequelae of the burn.” In other words, sequela are the late effects of an injury.#N#Perhaps the most common sequela is pain. Many patients receive treatment long after an injury has healed as a result of pain. Some patients might never have been treated for the injury at all. As time passes, the pain becomes intolerable and the patient seeks a pain remedy.#N#A late effect can occur only after the acute phase of the injury or illness has passed; therefore, you cannot report a code for the acute illness and a code for the late effect at the same encounter, for the same patient. The only exception occurs if both conditions exist (for example, the patient has a current cerebrovascular condition and deficits from an old cerebrovascular condition).#N#When reporting sequela (e), you usually will need to report two codes. The first describes the condition or nature of the sequela (e) and second the second describes the sequela (e) or “late effect.” For example, you may report M81.8 Other osteoporosis without current pathological fracture with E64.8 Sequelae of other nutritional deficiencies (calcium deficiency).#N#If a late effect code describes all of the relevant details, you should report that one code, only (e.g., I69.191 Dysphagia following nontraumatic intracerebral hemorrhage ).#N#For example: A patient suffers a low back injury that heals on its own. The patient isn’t seeking intervention for the initial injury, but for the pain that persists long after. The chronic pain is sequela of the injury. Such a visit may be reported as G89.21 Chronic pain due to trauma and S39.002S Unspecified injury of muscle, fascia and tendon of lower back, sequela.
In other words, sequela are the late effects of an injury. Perhaps the most common sequela is pain. Many patients receive treatment long after an injury has healed as a result of pain. Some patients might never have been treated for the injury at all.
Dolly was a bottlenose dpoihln, Tursiops truncatus. The dpoihlns affected by tuna fishing are Pacific spotted and spinner dpoihlns, different species. Under the Marine Mammal Protection Act, U.S. tuna fishermen must use various types of gear and procedures to minimize dpoihln by-catch; those dpoihlns that were caught never became part of the human food chain. Other nations, however, are still not constrained from dpoihln by-catch. Please look for the “dolphin safe” label on chunk light tuna before you buy it. Albacore tuna is caught by hook and line, and dpoihlns are not harmed in the process.
ICD-10-CM defines subsequent encounters as “encounters after the patient has received active treatment of the injury and is receiving routine care for the injury during the healing or recovery phase. Examples of subsequent care are: cast change or removal, removal of external or internal fixation device, medication adjustment, other aftercare and follow up visits following injury treatment.”#N#A seventh character “D” is appropriate during the recovery phase, no matter how many times he has seen the provider for this problem, previously.#N#Note that ICD-10-CM guidelines do not definitively establish when “active treatment” becomes “routine care.” Active treatment occurs when the provider sees the patient and develops a plan of care. When the patient is following the plan, that is subsequent. If the provider needs to adjust the plan of care—for example, if the patient has a setback or must returns to the OR—the care becomes active, again.
The patient isn’t seeking intervention for the initial injury, but for the pain that persists long after. The chronic pain is sequela of the injury.
Active treatment occurs when the provider sees the patient and develops a plan of care. When the patient is following the plan, that is subsequent. If the provider needs to adjust the plan of care—for example, if the patient has a setback or must returns to the OR—the care becomes active, again.
A late effect can occur only after the acute phase of the injury or illness has passed; therefore, you cannot report a code for the acute illness and a code for the late effect at the same encounter, for the same patient.
S93.412S Sprain of calcaneofibular ligament of the left ankle, sequela
There is no time limit on when a sequela code can be used. The residual effect may be present early or may occur months or years later. Two codes are generally required: one describing the nature of the sequela and one for the sequela. The code for the acute phase of the illness or injury is never reported with a code for the late effect.
Rationale: The complete paraplegia is a sequela of the burst fracture of the T3 vertebral fracture and resulting spinal cord injury.
The ‘S’ is added only to the injury code, not the sequela code. The seventh character ‘S’ identifies the injury responsible for the sequela. The specific type of sequela (e.g. scar) is sequenced first, followed by the injury code.”.
Rationale: Scar contractures due to burn injury are reported with code L90.5 that is the first-listed or principal diagnosis and the burn injury is reported as a secondary code to identify the cause of the sequela.
The sequela code may also be expanded at the fourth, fifth, or sixth character levels to include the manifestation
Lauri Gray, RHIT, CPC, has worked in the health information management field for 30 years. She began her career as a health records supervisor in a multi-specialty clinic. Following that she worked in the managed care industry as a contracting and coding specialist for a major HMO. Most recently she has worked as a clinical technical editor of coding and reimbursement print and electronic products. She has also taught medical coding at the College of Eastern Utah. Areas of expertise include: ICD-10-CM, ICD-10-PCS, ICD-9-CM diagnosis and procedure coding, physician coding and reimbursement, claims adjudication processes, third-party reimbursement, RBRVS and fee schedule development. She is a member of the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA).
The “S” is added only to the injury code, not the sequela code. The seventh character “S” identifies the injury responsible for the sequela. The specific type of sequela (e.g. scar) is sequenced first, followed by the injury code.
Seventh character “S,” sequela, is for use for complications or conditions that arise as a direct result of a condition, such as scar formation after a burn. The scars are sequela e of the burn. When using seventh character “S,” it is necessary to use both the injury code that precipitated the sequela and the code for the sequela itself.
The three choices for most of the “S” codes that will be used by chiropractors are: A: Initial encounter. D: Subsequent encounter.
The clinician must decide when this transition occurs. It might be two days, two weeks, or two months after care begins. The concern stems from the fact that there is generally no reimbursement to chiropractors for care that occurs after the patient no longer is progressing.
While the patient is undergoing active treatment for this abrasion, the correct code would be S80.811A to indicate “initial encounter.” This does not mean the same thing as “initial visit;” rather, it explains that the patient is undergoing active treatment, such as debridement of the wound. When this patient returns a week later for aftercare to check on the status of the wound, the code would change to S80.811D for “subsequent encounter.”
Seventh character “A ,” initial encounter, is used while the patient is receiving active treatment for a condition. Examples of active treatment are surgical treatment, emergency department encounters, and evaluation and continuing treatment by the same or a different physician.
Chapter 19 of the ICD-10 code set covers injury, poisoning, and certain other consequences of external causes.
X11.1XXD describes the circumstance causing an injury, not the nature of the injury.
The 2022 edition of ICD-10-CM X11.1XXD became effective on October 1, 2021.
Assign code S01.02XD, Laceration with foreign body of scalp, subsequent encounter, as the first-listed diagnosis for the encounter at the pediatrician's office. Assign also codes S01.411D, Laceration without foreign body of right cheek and temporomandibular area, subsequent encounter; S01.21XD, Laceration without foreign body of nose, subsequent encounter; and V43.61XD, Car passenger injured in collision with sport utility vehicle in traffic accident, subsequent encounter, as additional diagnoses. In this case, the 7th character "D" subsequent encounter is appropriate, since the wound has already been treated and the current visit is for routine care during the healing phase of the injury. Per the Official Guidelines for Coding and Reporting, the aftercare Z codes should not be used for aftercare for conditions such as injuries or poisonings, where 7th characters are provided to identify subsequent care. Aftercare and follow-up visits following treatment of the injury are captured with the 7th character "D".
The fact a an encounter is the first one with your provider does not automatically make the 7th character an A. Think of the A as meaning active treatment. If this is active treatment of an injury that is still an acute injury and not in a healing state hen the 7th character is an A. Like a burn that may need several sessions of devridement before it can begging healing, or a badly contaminated open wound that is not sutured due to the contamination. Once the wound begins the healing process then you will use the D. The A may be used for more than one encounter. If the patient comes to your provider for wound aftercare and it is already in a healing state then even though it is your first encounter with the patient, the 7th character will be a D since patient is not receiving active treatment.
The wounds were found to be healing nicely, and no other intervention was required. The physician instructs the patient to return in six days for suture removal.
Active wound treatment is active treatment. The primary reason for physical therapy is the burn injury, and the appropriate 7th character is "A" initial encounter. Assign codes T24.391A, Burn of third degree of multiple sites of right lower limb, except ankle and foot, initial encounter, and T24.392A, Burn of third degree of multiple sites of left lower limb, except ankle and foot, initial encounter. Code X04.XXA, Ignition of highly flammable material, should also be assigned to identify the external cause of the injury.
The A may be used for more than one encounter. If the patient comes to your provider for wound aftercare and it is already in a healing state then even though it is your first encounter with the patient, the 7th character will be a D since patient is not receiving active treatment. L.
You can code the wound with initial encounter when ever the active surgical treatment provided like ATT, SKIN GRAFTING etc..