Orthopedic Coding Alert

Remember, open and closed fracture knowledge essential.

Orthopedic coders will be dealing with fracture care patients often - even though an orthopedist can perform a myriad of other services for patients, every practice will set its share of broken bones.

That means that you must stay sharp when it comes to fracture coding, and firmly atop all of the intricacies involving terminology,

Check out this FAQ with Sharon Richardson, compliance officer of EM Services at Emergency Groups' Office in San Dimas, California, for a primer on what every orthopedic coder should know about these common fracture terms.

Q: What's the difference between an open and closed fracture?

A: A closed fracture involves a break that has not broken the skin. So, if there is no evidence of a breach of the skin in the encounter notes, you likely have a closed fracture claim on your hands.

Conversely, "an open fracture is when the bone has punctured through the skin or there is a significant break in the skin directly over the fracture site - not an abrasion or superficial laceration," explains Richardson.

As you might surmise, open fractures are usually pretty serious business. General practitioners will rarely treat open fractures, as "there is significant risk of infection, and open fracture treatment usually requires some type of fixation device," Richardson says.

Meaning: Your orthopedist is in a unique position to provide open fracture treatment, and she could be called upon often to perform these high-paying procedures. As a coder, be ready to recognize an open fracture treatment or risk undercoding for your provider's services.

Q: What kinds of fractures require physician manipulation?

A: Coders must also decide if the physician performed manipulation before choosing a fracture care code, so this is an important question.

Examples of fractures that require manipulation include angulated, displaced, and dislocated. If you see any of these terms on the encounter form, be on the lookout for evidence of manipulation.

Consider this detailed clinical scenario from Richardson involving fracture care with manipulation:

A patient presents to with pain and inability to ambulate due to pain in his right lower extremity due to a fall. The orthopedist can see that there is swelling and ecchymoses just above the right ankle. The orthopedist medicates the patient with intravenous dilaudid for his pain and orders an x-ray of the ankle and tibia-fibula. The x-ray shows a moderately angulated fracture of the distal portion of the tib-fib shaft; the physician then manipulates the leg to realign the bones. A post-reduction x-ray shows the bones to be well-aligned. The orthopedist then places the patient's lower extremity in a cast and instructs him on postoperative care.

For the fracture care in this scenario, you'd choose a "with manipulation" code: 27752 (Closed treatment of tibial shaft fracture (with or without fibular fracture); with manipulation, with or without skeletal traction).