Orthopedic Coding Alert

Get to know the fracture terms in-depth, and the right diagnosis and procedure codes will follow Can you differentiate a boxer's fracture from a Bennett fracture? Do you know the difference between a depressed fracture and a greenstick? If not, it's time for a quick reminder of these fracture types, and you-ll increase your coding savvy quickly and easily.
 
Because your orthopedic surgeon won't always dictate his notes using the same terms you-ll see in the CPT and ICD-9 manuals, a firm grasp of anatomic knowledge is important. For the next few months, Orthopedic Coding Alert will be running a column in each issue that can help you connect anatomic terminology to the right diagnosis and CPT codes. In this issue, we-ll break down fracture care and how each term fits into your claims process.

Differentiate Between Closed and Open Fractures Most orthopedic coders can't go a whole day without coding a fracture chart. Because fractures make up so many diagnoses in orthopedic practices, it's important to learn the terminology that physicians use when describing these conditions.

Your first step should be to determine whether the physician treated an open or closed fracture. If you look at the ICD-9 Manual, you-ll note that most fractures are listed first by site, and then according to whether the fracture is closed or open.

For example: Suppose your surgeon diagnoses a patella fracture. In the index of the ICD-9 manual, you look up -fracture,- after which you will see a listing of the sites. If you move to -knee,- the subheading will say -closed 822.0,- followed by -open 822.1.- Therefore, if you don't know whether the surgeon diagnosed an open or closed fracture, you won't be able to assign an accurate code. Closed fracture -- Closed fractures refer to fractures in which the skin remains intact, with no broken skin or protruding bone at the site, as seen below. Look for terms like -comminuted,- -transverse,- -depressed,- -elevated,- -fissured,- -greenstick,- -impacted,- -linear,-  -march- and -simple.- In addition, most stress fractures are
closed fractures.

Tip: Unless the term -open- or -compound- appears in the diagnostic statement, you should most likely report a closed fracture code, according to the American Hospital Association's Coding Clinic. Open fracture -- The end of a bony fragment sticks through the skin (the older term is -compound fracture,- which some physicians may still document), or there is an opening between the skin and the fracture. -The precise technical definition is that the fracture hematoma communicates with an open wound,- says Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C.

You can know for sure whether your physician treated an open fracture if the documentation includes the words -compound,- -missile,- -puncture,- -open,- [...]