Documenting Fractures: A Monumental Task?

Insights

Published on September 5, 2018

There are 17,045 diagnosis codes that relate to fractures, of which 10,582 diagnosis codes distinguish right versus left, so details are everything. With all these new codes you will need to collect more information to insure proper billing.

In order to ensure proper coding we must have the following details:

The specific bone(s) that was injured.
Was the fracture open or closed?
Was the fracture displaced or non-displaced?
Was this an initial or subsequent visit?

Site of the Fracture

This includes which bone is broken and the specific location on the bone. Some of the terms to describe the location on the bone are distal end, proximal end, shaft, medial and head. It is also very important to identify the left or right side of the body. For example, a patient fractures his forearm. The forearm consists of two bones the radius and ulna, so it is important that the provider document which bone(s) were fractured to ensure the fracture is coded properly. Providers should avoid using language which includes more than one bone, such as forearm, ankle or wrist. Instead state the specific bone, such as radius, lateral malleolus or carpal.

Type of Fracture

There are various types of fractures traumatic, pathologic, greenstick, transverse, oblique, and spiral. Providers should also document whether a fracture is open or closed. If a fracture type is not documented coders are instructed to code as closed. If a fracture is not documented as displaced or non-displaced, coders are instructed to code as displaced.

Encounter

ICD-10 codes have a seventh character which designates the episode of care as initial, subsequent or sequela.

A – initial closed fracture
B – initial open fracture
D – subsequent routine healing
G – subsequent delayed healing
K – subsequent nonunion
P – subsequent malunion
S – sequela

There are many other seventh characters that provide an extra level of detail that can be coded with open fractures. Open fractures are grouped into three types based on the cause of injury, extent of soft tissue damage and amount of bone damage.

B – initial encounter for open fracture type I or II
C – initial encounter for open fracture type IIIA, IIIB, IIIC
E – subsequent encounter for open fracture type I or II with routine healing
F – subsequent encounter for open fracture type IIIA, IIIB or IIIC with routine healing
H – subsequent encounter for open fracture type I or II with delayed healing
J – subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
M – subsequent encounter for open fracture type I or II with nonunion
N – subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
Q – subsequent encounter for open fracture I or II with malunion
R – subsequent encounter for open fracture IIIA, IIIB, or IIIC with malunion

As you can see coding fractures can be a bit complicated. However, the more specific the documentation is, the more likely it is that coding and billing staff can select accurate codes and maximize reimbursement.

By: Angela M. Smith, CCA, CANPC

Coding Department Assistant Manager