Don't get bogged down by confusing ICD-10 characters-- especially the ones you find at the end of the line. With terminology that tends to run counter to intuition at times, selecting the correct seventh-character under ICD-10 can be a challenge, as
we reported this week.
Here's a hard-and-fast rule for wound care and surgical procedures: Go with character "A," which refers to an initial encounter, for any active treatment, even if it's the 10th or hundredth time you've seen the patient.
Otherwise, choose seventh-character "D" when the treatment is no longer active.
Check out this example, provided by Angie Comfort, senior director of health information management practice excellence for AHIMA in Chicago.
Scenario: A snowboarder crashed at a ski resort and fractured his right wrist. He had surgery to repair the fracture with an external fixation device.
- ICD-10-CM code: S62.101A (Fracture, unspecified carpal bone, right wrist, initial encounter for closed fracture)
- CPT codes: 25635 (Closed treatment of carpal bone fracture with manipulation), 20692 (Application of a multiplane, unilateral, external fixation device)
Return visit: The same patient comes in six weeks later to have the external hardware and fixation device removed.
- ICD-10-CM code: S62.101D (Fracture, unspecified carpal bone, right wrist, subsequent encounter for fracture with routine healing)
- CPT code: 20694 (Removal, under anesthesia, of external fixation device)
Because the removal of the fixation device is considered aftercare, the correct choice is character D for the fracture code.