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These 7 th characters identify two episodes of care that incur distinct management options and costs. Coding time one area that will require close attention is the change in the existing initial and subsequent care code descriptors when it comes to time For each subsequent day that your surgeon provides e/m services, you can bill the appropriate subsequent hospital care code
If your surgeon is not the admitting physician, but provides an e/m service for a medicare patient on the admission date, you can report a subsequent hospital care code. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded. The use of the initial vs subsequent vs sequela is not based on the encounter being the first encounter with the provider
It is based on the status of the injury
If the fracture was appropriately and definitively treated in the er and your provider is following up on that care then you use the 7th character for subsequent even if this is a new patient encounter or you are seeing the patient. Subsequent means aftercare subsequent equates to aftercare treatment, and may be appropriate to code even when it’s the provider’s first time seeing the patient 99232 subsequent hospital inpatient or observation care, per day, for evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of decision making
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