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Initial vs. subsequent. New vs. established. Will it be an issue?

ICD-10 Trainer, November 11, 2011

Will the new ICD-10-CM concept of using seventh character code extensions to identify initial encounters vs. subsequent encounters cause additional confusion in relation to professional services, for which concepts of new visits vs. established visits are already at times a conundrum?

Many times providers select their own diagnosis and procedure codes for the billing staff. In this day and age, providers commonly employ electronic tools to assist in selecting codes, so will requiring information such as whether a patient is new or established for selection of evaluation and management (E/M) codes and then identifying whether a condition applies for an initial vs. subsequent encounter for the diagnosis codes possibly leave room for error?

Let’s look at the definitions for the seventh character extensions in ICD-10-CM. Per the ICD-10-CM Official Guidelines for Coding and Reporting in reference to Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes:

  • A: Initial encounter. Use this when the physician actively treats the condition during the initial encounter (e.g., surgical treatment, ED encounter, evaluation by new physician).
  • D: Subsequent encounter. Use this for encounters after the physician performs the initial treatment, but the patient continues to receive care during the healing or recovery phase (e.g., cast change/removal, removal of fixation, medication adjustment).