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 assigned based on the encounter for the treatment of the injuries. 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. Therefore, 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 is
A – Initial Encounter
D- Subsequent Encounter
S – Sequela
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.
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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.
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.