In ICD 9, we have straight codes for injuries or external cause of injuries. However, ICD 10 has different set of codes for injuries. Here the injuries are divided into initial, subsequent and sequela encounter with the physician. Hence, the codes are very specific for the treatment of the injuries. Now in injuries we do not have to code for aftercare codes when the fracture is into healing phase, you just need to select the appropriate ‘7th’ character to coding the condition. This is one of the reason we have so many ICD 10 codes. Therefore, injuries in ICD 10 are very different compared to ICD 9. In ICD 10 the seventh character will give the information about the initial, subsequent or sequel encounter for injuries. The seventh character used for the injuries are

A – Initial Encounter

D- Subsequent Encounter

S – Sequela  

Read also: Difference between Excludes 1 and Excludes 2 in ICD 10

When to code Initial Encounter

The seventh character ‘A‘ is used when an “active treatment is given to patient for the injury in the initial encounter”. Example for active treatment can be a surgical treatment, emergency treatment and evaluation and management by a new physician. The word “active” treatment should be understood very clearly before assigned initial encounter for the injuries.

For example, if the patient is treated for a fracture by an ER physician and again reduced by an orthopedician next day, both are considered as an active treatment and the injuries will be coded as initial encounter by the seventh character ‘A‘ only. Here both ER physician and Orthopedician worked on the same diagnosis and provided active treatment.

Now, in same scenario if the patient comes with a ER physician with fracture and the fracture is treated with placing a splint and then the patient goes for a follow-up visit with the orthopedician for the same diagnosis, where the orthopedician only recheck the fracture without giving any active treatment. In such case, the second encounter with orthopedician is a subsequent encounter with seventh character D for the injury.

Read also: When to use Z codes in ICD 10

When to code Subsequent Encounter

There are many cases where the patient revisits to his physician. The few examples are for refilling his medicine, for rechecking his healing fracture or follow-up visit for treatment of any injury. Most of the case includes the removal or change of cast and removal of external or internal fixation device. Hence, the cases for subsequent encounter are assigned with the seventh character ‘D‘ for the injury codes.

Subsequent encounter codes are used to avoid using multiple codes. Earlier, in ICD we used to use mutliple codes for coding Status post fracture, for frature screw fixation, for routine healing ( callus formation) exams. V codes like V54.09, V54.89 or V54.01 are used as primary primary codes in ICD 9 followed by fracture code.

But, in ICD 10 we have to code only one diagnosis for these scenarios by just changing the 7th character as “D“.

If the fracture is under routine healing, we can directly use ” D” as 7th character.

You can differentiate between the use A and D by the use of active treatment or not.

Read also: New coding Guidelines for Z3A category for diagnosis coding

When the patient go to different physicians for same diagnosis

If the patient has a fracture and goes to a physician, it is a first and active treatment (A).  And when the patient again after few days goes to another physician for same diagnosis, then also it is considered as active treatment by the physician. Since. Patient encounter was first or initial for each physician, the reported diagnosis will be coded as initial encounter (A)

When the patient visits the same physician for same diagnosis treatment.

Here, the patient goes to the same physician for initial or subsequent encounter. In such case, the first or intial encounter will be coded as active treatment. All the subsequent encounters, will be reported as “D” as 7th character.

In short, all aftercare or follow-up visit to check the status  of injuries will be coded as subsequent encounter for same physician.

Read also: Difference between Followup and Aftercare Z Codes

When to code Sequela

Seventh character ‘S’ is used for coding “complication or condition that arise for the direct result of the injury such as scar formation after a burn”. The scars are sequela of the burn. Sequelas are late effects of an injury. For example, when the patient has an injury and does not seek any intervention for the initial injury, but the pain persists for long time. This chronic pain is a late effect for the untreated injury of the past. Such chronic pain due to injury are coded for the patient visit to the physician followed by the injury code with seventh character ‘S’ denoting sequel or late effect.