Anesthesia Coding Alert

Start by determining whether it’s traumatic or pathologic.

Fracture coding can be one of the most complex areas of ICD-10, but that doesn’t mean it has to break your streak of successful claims. Start by understanding the type of fracture you’re reporting, and then move to the specifics of code selection.

Definition: A fracture is either traumatic or pathologic. A pathologic fracture occurs when a bone breaks in an area that is weakened by another disease process. Causes of weakened bone include tumors, infection, and certain inherited bone disorders. There are dozens of diseases and conditions that can lead to a pathologic fracture or dislocations. A pathologic fracture usually occurs with normal activities — patients may be doing very routine activities when their bone suddenly fractures or dislocates. The reason for a fracture is that the underlying disease process weakens the bone to the point where the bone is unable to perform its normal function. 

Important: ICD-10-CM has three pathologic fracture categories:

• Due to neoplastic disease
• Due to osteoporosis
• Due to other specified disease.

Example: The orthopedist performed surgery on a 72-year-old man to repair a fracture of the right femur shaft. He was originally diagnosed with left upper lobe carcinoma 5 years ago, and then several months ago, he was diagnosed with metastatic bone cancer (from the lung). This femur shaft fracture is a result of the metastatic cancer. The patient’s lung cancer has already been treated with radiation, and the patient no longer has any evidence of an existing primary malignancy. What ICD-10 code(s) should you report?

Solution: In this scenario, the pathologic fracture to the shaft of the femur was due to neoplastic disease. Begin with category M84 (Disorder of continuity of bone), then pinpoint the reason behind the fracture for the code’s fourth character. Your choices are 3 (Stress fracture), 4 (Pathological fracture, not elsewhere classified), 5 (Pathological fracture in neoplastic disease), 6 (Pathological fracture in other disease), 8 (Other disorders of continuity of bone), or 9 (Disorder of continuity of bone, unspecified). You’ll choose 5 in this example because the patient’s fracture is due to neoplastic disease.

The next two characters of the code indicate the location of the fracture. You have nine general anatomic sites from which to choose, then will drill down to a more specific location. For this patient you’ll select 5 for “pelvis and femur,” then 1 for “right femur.”

You’re instructed to also include a seventh character indicating the level of encounter. That information might not be in the anesthesiologist’s record, so you may need to contact the surgeon’s office to verify what to list as the code’s seventh character (such as A for “initial encounter for fracture”).  

Based on the information you know, the correct fracture diagnosis is M84.551~ (Pathological fracture in neoplastic disease, right femur) with a final character added for the encounter. You’ll also include three other diagnoses associated with the patient’s history:

• C79.51— Secondary malignant neoplasm of bone
• Z85.118 — Personal history of other malignant neoplasm of bronchus and lung
• Z92.3 — Personal history of irradiation.

Next month: In the next issue of Anesthesia Coding Alert, we’ll review how to choose the correct diagnosis code for traumatic fractures.