In the recent webinar, ICD-10: 4 Steps to Success, participants got a great overview of ICD-10, the impact on practices, and the 4 steps to help ensure success. Speaker Michelle Cavanaugh also spent nearly 20 minutes answering a wide range of questions from attendees, including many about the 7th character and how the coding works for initial, subsequent and sequela visits. In this blog post, we're sharing those answers.
Prior to the questions, here is a quick overview of the initial, subsequent, a sequela coding:
A=Initial Encounter: Used while the patient is receiving active treatment for the condition being diagnosed. Examples could be surgery encounter, ER, evaluation and treatment by a new physician.
B=Subsequent Encounter: Used for care after the patient has received active treatment for the condition and is now receiving routine care during the healing or recovery phase. For example, cast change or removal, medication modification, follow up care for that injury or condition.
S=Sequela: Used for complications or conditions that the patient might develop as a result of the initial condition or injury. We used to call these late affects. Examples might be a joint contracture, a scar, painful hardware after an arthrodesis was done.
Q: Does every visit require the initial, subsequent, or sequela coding?
A: No. Refer to the ICD-10 code book to guide you on which diagnosis codes use this coding convention.
Q: Is the 7th character required or used in all specialties?
A: No, it is not. Refer to the ICD-10 code book to guide you on which diagnosis codes use this coding convention.
Q: Is 7th character “A” only for new patients, or can it be an established patient with this new diagnosis?
A: The seventh character “A” is used only on selected codes. Refer to the ICD-10 code book to guide you on which diagnosis codes use this coding convention. It would be appropriate to use it on a patient receiving initial treatment for that diagnosis.
Q: Is the sequela encounter the final encounter of treatment? So if the patient had 4 visits there would be 1 initial visit, 2 subsequent visits, and then the sequela visit would be billed once the issue is determined to be resolved?
A: No. The sequela would only be applicable to any long-term or residual effect from the initial injury. If none existed then it would be appropriate to only have diagnosis coding for initial and subsequent visits.
Q: Do the “A” and “D” suffix for initial and subsequent visits go with 99213 vs 99203 if they are new to our practice but following up from ER?
A: Since 99213 and 99203 are CPT codes, you would select the proper one based on whether the patient is new to your practice or already established.
Q: Is it accurate to use the initial encounter 7th character multiple times before using the subsequent encounter 7th character.
A: This would be an unusual situation. It would be most commonly seen in the instance of an ER patient who is being treated by multiple providers for an initial injury. For example, the patient with a fracture is seen by the ER doctor and the radiologist to diagnosis and initiate treatment so they would both code with a diagnosis for initial encounter.
Q: How do we know that the patient has been seen for an issue already? Most of our patients are geriatric with dementia and Alzheimer’s.
A: If the patient was seen in your practice, this information will be in the patient’s record. If the patient was referred to you then you should have a referral from the other provider. If neither of these are the case, you may be able to figure this out when taking the history or through a caregiver. Also, remember not all ICD-10 codes require the use of the 7th character to delineate the visit is a new or subsequent care visit. See the ICD-10CM code book to become familiar with the applicable diagnosis codes.
You can get more tools and resources at the Kareo ICD-10 Resource Center.