Inpatient Facility Coding & Compliance Alert

Question: The code M84.551A has a seventh character of A.

Another code S82.852K has a seventh character of K. How do we figure out the difference?

Utah Subscriber

Answer: You need to be careful about your seventh characters when you code for fractures. In the pathological or stress fracture category (M84.3-M84.6), you have the following options:

• A – Initial encounter for fracture (surgical treatment, ED encounter, and treatment by a new physician.)
• D – Subsequent encounter for the fracture with routine healing
• G – Subsequent encounter for the fracture with delayed healing
• K – Subsequent encounter for fracture with nonunion
• P – Subsequent encounter for fracture with malunion
• S – Sequela

Examples of subsequent treatment include cast change or removal, removal of external or internal fixation device, medication change, other follow-up visits.

Gustilo open fracture classification: Some fracture categories such as open fractures provide for seventh characters to designate the specific type of open fracture such as:

• B – initial encounter for open fracture type I or II (open NOS or not otherwise specified)
• C – initial encounter for open fracture type IIIA, IIIB, or 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 type I or II with malunion
• R – subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion

Make certain that you know what seventh character to apply to your fracture care code.