Fracture Coding with 7th Character Extenders

With the implementation of ICD-10-CM, coding for fractures will require an in-depth knowledge of the patient’s course of treatment. ICD-10-CM will require more precise location choices, laterality, episode of care, and indication as to the healing process of the fracture. ICD-10-CM indicates that a fracture not indicated as open or closed should be coded to closed (which is the same as ICD-9-CM currently reads). ICD-10-CM also indicates that a fracture not indicated whether displaced or non-displaced should be coded to displaced (ICD-9-CM does not specifically state this).

7th character extenders are utilized for fracture code assignment in ICD-10-CM to indicate the encounter. The encounter denotes where the patient is in the treatment cycle: initial, subsequent, or sequel (late effect). In some cases there are 16 choices for the 7th character extenders for a fracture. When you look at the choices in detail, you can see that it is a major improvement to the process of coding the patient’s diagnosis. For instance, when coding for traumatic fractures, the initial visit by the provider will require the “initial encounter” 7th character extender to indicate the patient is receiving active medical treatment for their condition:
A – initial encounter for closed fracture
B – initial encounter for open fracture type I or II initial encounter for open fracture NOS
C – initial encounter for open fracture type IIIA, IIIB, or IIIC

Initial encounters include first visits, evaluation by a new provider, and surgical intervention.

When the patient returns for subsequent visits, it will be necessary to indicate his or her healing process with the appropriate 7th character, including:
D – subsequent encounter for closed fracture 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
K – subsequent encounter for closed fracture with nonunion
R – subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion

These 7th character extenders are used to indicate the patient has completed active medical treatment and is receiving routine care during the healing or recovery phase. The 7th character extender S is used to indicate a sequela, or late effect has occurred.

Orthopaedic Surgery COSC

While code assignment for fractures may take a little longer with ICD-10-CM, more precise, detailed code assignment will lead to faster claim adjudication and fewer record requests.

2 Responses to “Fracture Coding with 7th Character Extenders”

  1. Jean Rainone says:

    I still have one question. If the physician sees the patient for an initial visit, and writes an order for the patient to have therapy, is the first day of therapy an initial visit or a subsequent visit?

    Thank you.

  2. Nancy Grandmaison says:

    Hi John, I am an orthopaedic surgery coder. I am still very confused on the proper use of the malunion/nonunion codes and when to use them. Here is my example:

    82-year-old male with a history of a motor vehicle collision decades ago in which he suffered a proximal 3rd femoral shaft fracture. It was treated nonoperatively and healed with a significant malunion. What is the correct ICD-10 code to use if the patient is now having surgery for the malunion?

    Thank you
    Nancy Grandmaison, COSC

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