Decode Documentation to Code Fractures
The first three digits of a fracture diagnosis (ICD-9-CM) code describe the fracture location. For instance, codes series 800.xx-804.xx describes fractures of the skull, while code series 820.xx-829.xx describes fractures of the lower limbs. The fourth digit of a fracture code usually identifies the fracture as either “open” or “closed.” For example, ICD-9-CM 813.41 describes a closed Colles’ fracture, while 813.51 describes an open Colles’ fracture.
An open, or compound, fracture, is one in which there is a break in the integument at the fracture site or fracture hematoma. In other words, the end of a bony fragment sticks through the skin, or there is an opening between the skin and the fracture. Clinicians may classify an open fracture by grade (Grade I, Grade II, etc., with possible sub-classifications within each grade); when coding, all open fractures are treated the same.
Documentation language that could indicate an open or compound fracture includes “puncture,” “missile,” or “with foreign body.” A description of debridement (cleaning of the wound) may also indicate an open fracture. Providers should be careful to specifically identify open fractures because coding conventions dictate that a fracture not identified as open or closed should be classified as closed.
In a closed fracture, there is no protruding bone, the skin is not broken, and the risk of infection is less serious than with an open fracture. There are many varieties of closed fracture, such as “comminuted,” “depressed,” “elevated,” “fissured,” “greenstick,” “impacted,” “linear,” “march,” “simple,” “transverse,” etc. Most stress fractures are closed fractures.
Don’t confuse “complete” and “incomplete” with open and closed. A complete fracture involves the entire width of the bone, while an incomplete fracture does not. Similarly, “simple” and “complex” refer to whether the bone has fractured into two or more pieces, and are not synonymous with open and closed.