ED Coding and Reimbursement Alert

Question: We treated a patient with multiple fractured ribs and we reported a six-character code, but the claim was denied because we should have billed a seven-character diagnosis. We didn't see a seventh character option. Can you advise?

Codify Subscriber

Answer: When your physician treats multiple rib fractures, you'll likely link the CPT^® code to a diagnosis code in the S22.4-- group, depending on the laterality and number of fractures:

These ICD-10 codes are:

• S22.41-- -  Multiple fractures of ribs, right side
• S22.42-- - Multiple fractures of ribs, left side
• S22.43-- - Multiple fractures of ribs, bilateral
• S22.49-- - Multiple fractures of ribs, unspecified side.

Also: Be sure to add the appropriate seventh character to each code in the S22 category:

• A - Initial encounter for closed fracture
• B - Initial encounter for open fracture
• D - Subsequent encounter for fracture with routine healing
• G - Subsequent encounter for fracture with delayed healing
• K - Subsequent encounter for fracture with nonunion
• S - Sequela.

Unfortunately, without these seventh-character letters added, the claim will likely reject as having a truncated ICD-10 code. In most cases, an emergency department will apply either "A" or "B" since you aren't as likely to see a patient for a subsequent encounter or sequela.