The Central Office on ICD-10-CM and ICD-10-PCS has continued to receive questions regarding the use of ICD-10-CM’s 7th characters. The following examples are intended to help clarify the use of the 7th characters in various care settings:
Long-Term Care Hospital Example
An 84-year-old patient was admitted to our long-term care hospital (LTCH) for posttraumatic subarachnoid hemorrhage and subdural hematoma. She was treated medically at an acute care facility and was then transferred to our facility for continuation of the same treatment she had been receiving at the acute care facility. What is the appropriate 7th character for this encounter?
Assign codes S06.5X0A, Traumatic subdural hemorrhage without loss of consciousness, initial encounter, and S06.6X0A, Traumatic subarachnoid hemorrhage without loss of consciousness, initial encounter, for the subdural hematoma and subarachnoid hemorrhage. Although the patient was treated at the previous facility, the patient was transferred for continuation of active treatment.
Acute Care Hospital Example
Surgical treatment is provided in the Official Coding Guidelines as an example of active treatment for the selection of the 7th character for initial encounter for codes in Chapter 19. If a patient is admitted to a hospital with nonunion of a previously repaired fracture requiring removal of fixation device and now partial joint replacement, would this be considered a subsequent encounter or would surgery always be considered active treatment, and therefore assigned 7th character “A” initial encounter?
Assign the 7th character of subsequent care with nonunion (K, M, N), if provider documentation indicates nonunion in a patient that is status post-surgical treatment, and the patient is now receiving additional surgical treatment. This is consistent with the guidelines for initial versus subsequent encounter for fractures. The Official Coding Guidelines for ICD-10-CM section I.C.19.c.1 state: “Care of complications of fractures, such as malunion and nonunion, should be reported with the appropriate 7th character for subsequent care with nonunion (K, M, N,) or subsequent care with malunion (P, Q, R).
Report the 7th character “A” initial encounter, for patients that delayed seeking treatment for the malunion/nonunion.
The patient presents for surgical treatment of a malunion of a fracture of the humeral greater tuberosity. This is the first time the malunion is being surgically treated, and the patient did not delay treatment of the malunion. According to guidelines, surgical treatment is an example of active treatment and the 7th character “A” is assigned. However, the guideline for malunion states: “….other 7th characters, listed under each subcategory in the Tabular List, are to be used for subsequent encounters for treatment of problems associated with the healing, such as malunions, nonunions, and sequelae.” What is the appropriate 7th character for the initial surgical treatment of a malunion?
Assign the 7th character “P”, Subsequent encounter for fracture with malunion. The Official Coding Guidelines for ICD-10-CM section I.C.19.c.1 states: “Care of complications of fractures, such as malunion and nonunion, should be reported with the appropriate 7th character for subsequent care with nonunion (K, M, N,) or subsequent care with malunion (P, Q, R).”
The patient had previously undergone open reduction internal fixation of a fracture. Three days post-discharge the patient is readmitted due to pain at the fracture site. An x-ray noted improper alignment of the fracture. The internal fixation pins were revised to provide additional reinforcement to the fracture. Is improper alignment of the fracture synonymous with nonunion? Would this be coded as an initial encounter or subsequent encounter?
The patient presented with improper alignment of the fracture. It was not a nonunion of the fracture. This is still active treatment, so assign 7th character “A” initial encounter.