TrustHCS coding experts are sharing their knowledge. Here is some helpful information regarding initial vs. subsequent episode of care.
Episode of care designations are initial, subsequent or sequela for injuries, poisonings, and certain other conditions; and in some instances provides additional information about the injury.
Initial Episode of Care
- Traumatic fractures are coded using the appropriate 7th character for the initial encounter while the patient is receiving active treatment
- The appropriate 7th character for initial encounter should be assigned for a patient who delayed seeking treatment for the fracture, nonunion, malunion, etc.
- Examples of active treatment include: surgical treatment, emergency room encounter, and evaluation and active treatment by a new physician
Subsequent Episode of Care
- Fractures are coded using the appropriate 7th character for subsequent care for encounters after the patient has completed active treatment of he fracture/injury and is receiving routine care for the fracture/injury during the healing or recovery phase
- Care of complications of fractures, such as malunion and nonunion, should be reported with the appropriate 7th character for subsequent care with nonunion (K,M,N) or subsequent care for malunion (P,Q,R)
- Examples of subsequent treatment include: cast change or removal, removal of external or internal fixation device, medication adjustment, and follow-up visits following fracture treatment.
- Care for complications of surgical treatment for fracture repairs during the healing or recovery phase should be coded with the appropriate complication codes
- A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone
- The aftercare Z codes should not be used for aftercare for traumatic fractures. For aftercare of a traumatic fracture, assign the acute fracture code with the appropriate 7th character (initial, subsequent, sequela)