Many physician encounters are due to injury, and the difference between disease and injury can be blurred which can cause problems for medical coders and billers. A patient may suffer bruising due to disease, for example, but have no history of injury. This is why, for the purposes of coding, you want to be familiar with the varying levels of injury:

  • Acute injury: Damage to the body incurred by accident

  • Chronic injury: Damage to the body that is a result of overuse or aging

Treatment may differ depending upon whether the injury is acute or chronic. With an acute injury, the injury has just happened, and the tissue in question is still viable. A chronic injury, on the other hand, has occurred over time or is a once-acute injury that has only partially healed.

Often, treatment of a chronic injury requires additional work: A surgeon may need to remove non-viable tissue or possibly use tissue grafts to successfully complete the repair. Thus, a chronic injury is often more time-consuming because the body’s tendency to heal itself can result in scar tissue (called fibrosis).

If you have any question about whether the injury is acute or chronic, investigate further before choosing a procedure code. If the patient history is available for review, you can abstract the information you need to choose the correct code.

In this case, you would review the patient history to see when the patient first came in for treatment, or you would look for the patient information page to see whether the patient indicated when the injury occurred.

Many times, patients say that they have no idea why the problem occurred. In this situation, you probably have to use chronic injury-related codes unless the provider says otherwise.

Because the story may be more complicated than a one-time incident, don’t assume that an injury is acute. When you’re unsure, investigate. Check for clues in the report. For example, words such as pathological often indicate a disease process that would point to chronic, not acute, injury.