Orthopedic Coding Alert

The first code (M84.551A) mentioned in the article “2 Scenarios Untangle Your Pathologic/Traumatic Fracture Code Diagnoses” has a seventh character of A. In the second solution, code S82.852K has a seventh character of K. Do you know the difference? You need to be careful about your seventh characters.

In the pathological or stress fracture category (M84.3-M84.6), you have the following options:

• A – Initial encounter for fracture
• 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

For instance, you would use the seventh character A at the first encounter with a physician. This includes surgical treatment, ED encounter, and treatment by a new physician.

You would use the seventh character D for follow-up visits. Examples of subsequent treatment include cast change or removal, removal of external or internal fixation device, medication change, other follow-up visits.

Traumatic Fractures Seventh Characters Differ

Seventh characters assigned in this chapter are identified at the category level to indicate initial encounter, subsequent encounter, or sequela.

Fracture seventh characters are expanded to include:

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

P – subsequent encounter for fracture with malunion

S – sequela

Some fracture categories provide for seventh characters to designate the specific type of open fracture (these designations are based on the Gustilo open fracture classification):

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.