ICD-10 Training | ICD-10 Terminology and 7th Digits

Alicia: Oh, another ICD-10, imagine that. This was a question that had come in, I believe, in the forum.

Q: Torus fracture of upper end of right humerus, initial encounter (with Dr. A) for closed fracture. That's the proper code for that S42.271A. Then, the patient comes back and it's the same thing, subsequent encounter for fracture with delayed healing (with Dr. A) the original doctor. So, the "A" at the end indicates initial encounter. The "G" on the second code indicates this is a subsequent encounter and it has delayed healing. What's so great is that you couldn't do that in ICD-9.

"Suppose the patient seeks out Dr. B at another practice to go to when they experience delayed healing...would it still be coded S42.271G even though it was the initial visit for that doctor?"

This is really, really interesting. When it came to the forum, I answered it and I think I wrote some information about it. But then, when we put it on the slide, I really went in to double check the guidelines and stuff. I kind of gathered what I had said, so I called my fellow AAPC ICD-10 auditors just to confirm that what I was thinking was correct and she agreed with me.

A: There's an excellent picture of that particular fracture which I went and found, which is really awesome. Again, this is a really, really good question. You have to consider this is a subsequent visit so the character G -- and they're called characters instead of digits now because you have numbers and letters -- with a different physician because the character is not referring to what is being done to the patient but the status of the diagnosis. A different physician might be a consult or a 2nd opinion but the fact is the case diagnosis had not changed.

So, think of it this way, this is a comparison I came up with in my little brain: If a person takes an apple to another person and that person states that's a Red Delicious apple (that's the diagnosis -- that is a Red Delicious apple). A day later comes back and asks and is told it is now a Red Delicious apple that has been cut in half. That doesn't change the fact that it's a Red Delicious apple. He goes to the second person and is told that it's still a Red Delicious apple that has been cut in half.