7th Character for Cast Re-application

Question:

We are a bit confused about what 7th character code we should use when the patient is being seen in follow-up for a fracture. The initial encounter was reported with the “7th character” for the initial evaluation and application of cast or splint. When the patient returns and the surgeon re-applies a new cast, do we use the 7th character code for active treatment or the 7th character code for routine healing?

Answer:

Thank you for your inquiry. You are not alone in your confusion even 8 years after ICD 10 was implemented. You are correct to use the “initial treatment” (sometimes referred to as the active treatment) code for the initial evaluation of the patient. If the treatment plan is to apply a cast, and the patient returns, they are stable, healing has begun, the correct 7th character code for the fracture will be the “routine healing or follow-up care.”

Other examples of when you might use the 7th character for routine healing/subsequent encounter, in addition to the cast/splint re-application, are:

· Dressing change or removal

· Staple or suture removal

· Removal of external or internal fixation device

Some of the confusion stems from references to “initial” treatment and “active” treatment.

ICD identifies the 7th character, based on the location and type of fracture, to be:

• Initial

• Routine

• Delayed

• Nonunion

• Malunion

*This response is based on the best information available as of 2/13/25.