7th Character Assignment for Injuries

7th Character Assignment for Injuries

Is your client missing out on correct payment due to inaccurate 7th Character Assignment for Injuries? The difference between “Sequela” and “Initial” encounter can result in underpayment to their facility.

Is your client missing out on correct payment due to inaccurate 7th Character Assignment for Injuries? The difference between “Sequela” and “Initial” encounter can result in underpayment to their facility.

Code and description

MS-DRG with MCC

MS-DRG with CC

MS-DRG without CC/MCC

APR-DRG

T82.858A - Stenosis of other vascular prosthetic devices, implants and grafts, initial encounter

314

RW 1.9582

315

RW 0.9658

316

RW 0.7401

206

T82.858S – Stenosis of other vascular prosthetic devices, implants and grafts, sequela

922

RW 1.4820

By default because no MCC

923

RW 0.8166

923

RW 0.8166

815

Impact to RW

0.4762 Underpayment

0.1492 Underpayment

0.0765 Overpayment

 

Determining the 7th Character assignment is based on the documented events found the medical record. It is important to review all pertinent notes that provide clues regarding the stage of treatment for the injury. According ICD-10-CM Official Guidelines for Coding and Reporting; Section I. Chapter 19.a. Application of 7th Character assignment:

  •  7th character “A”, initial encounter is used for each encounter where the patient is receiving active treatment for the condition. Examples of active treatment include: Surgical treatment such as fracture reduction; ED encounter for laceration repair; or Evaluation and continued treatment by the same or different physician.
  • 7th character “D” subsequent encounter is used for encounters after the patient has completed active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. The aftercare Z codes should not be used for aftercare for conditions such as injuries or poisonings, where 7th characters are provided to identify subsequent care. For example, for aftercare of an injury, assign the acute injury code with the 7th character “D” (subsequent encounter). Examples of subsequent encounters: Cast changes/removals; Removal of internal or external fixation devices after fracture has healed; Medication adjustments; Follow-up visits; X-ray to check on status of healing fracture; or ED visit for suture removal.
  • 7th character “S”, sequela, is for use for complications or conditions that arise as a direct result of a condition, such as scar formation after a burn. The scars are sequelae of the burn. The 7th character “S” identifies the injury responsible for the sequela. The specific type of sequela (e.g. scar) is sequenced first, followed by the injury code.

 

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