Orthopedic Coding Alert

Discover this new tool to help you ‘build’ a traumatic fracture code.

If you’re panicking about the upcoming ICD-10 implementation date and coding fracture codes, you’re not alone. Simplify these complicated seven character codes by breaking them down into pathologic and traumatic fractures.

Perfect Your Pathologic Fractures With Scenario 1

Scenario 1: My orthopedic provider saw a 72 year old man for a fracture of the right femur shaft. He was originally diagnosed with left upper lobe carcinoma 5 years ago, and then several months ago, he was diagnosed with metastatic bone cancer (from the lung). This femur shaft fracture is a result of the metastatic cancer. The patient’s lung cancer has already been treated with radiation, and the patient no longer has any evidence of an existing primary malignancy. What ICD-10 code(s) should I report?

Definition: First, you need to define this type of fracture. A fracture is either traumatic or pathologic. A pathologic fracture occurs when a bone breaks in an area that is weakened by another disease process. Causes of weakened bone include tumors, infection, and certain inherited bone disorders. There are dozens of diseases and conditions that can lead to a pathologic fracture or dislocations. A pathologic fracture usually occurs with normal activities — patients may be doing very routine activities when their bone suddenly fractures or dislocates. The reason for a fracture is that the underlying disease process weakens the bone to the point where the bone is unable to perform its normal function. 

Important: ICD-10-CM has three pathologic fracture categories:

• Due to neoplastic disease
• Due to osteoporosis
• Due to other specified disease

Solution: In this scenario, the pathologic fracture to the shaft of the femur was due to neoplastic disease. Therefore, the solution is:

• M84.551A — Pathological fracture in neoplastic disease, right femur, initial encounter for fracture
• C79.51— Secondary malignant neoplasm of bone
• Z85.118 — Personal history of other malignant neoplasm of bronchus and lung
• Z92.3 — Personal history of irradiation.

Now, check out traumatic fractures.

Highlight These Traumatic Fracture Details for Scenario 2

Traumatic fractures include much greater specificity in ICD-10-CM. For example, some of the information that may be found in fracture codes include:

• the type of fracture,
• specific anatomical site,
• whether the fracture is displaced,
• laterality,
• routine versus delayed healing,
• nonunions and malunions,
• identification of type of encounter.

Red Flag: In ICD-10-CM, a fracture not indicated as displaced or nondisplaced should be coded to displaced. A fracture not designated as open or closed should be coded to closed.

Scenario 2: Your physician sees a patient for increased pain in her ankle. She has had a previous trimalleolar fracture of the left ankle. After evaluation, he diagnoses a nonunion of her left trimalleolar fracture. What should you do?

Tool: Fracture scenarios are complicated, but here is a tool using the PCS coding logic to break down these traumatic fractures into simple charts. (Note: For this example, you will not review the full chart, just the row you need.)

So in this scenario, we know that we’re looking at the lower leg, specifically the ankle. The best root code we have is S82.8---. Following that row, you will find “trimalleolar” (character 5). You would stay in that row again, to find “displaced/left” (character 2). Finally, you would apply K (Subsequent encounter for closed fracture with nonunion).

Heads up: Did we know if this fracture was displaced or nondisplaced? Coding guidelines specify that if displaced versus nondisplaced is not indicated, the default is displaced.

Solution: You should report S82.852K (Displaced trimalleolar fracture of left lower leg, subsequent encounter for closed fracture with nonunion).

Do you think you need an aftercare code? No. Aftercare Z codes should not be used for aftercare of fractures. For aftercare of a fracture, assign the acute fracture code with the correct seventh character indicating the type of aftercare. (See “Here Are Your Seventh Character Possibilities for Fracture Codes”)

Heads up: If you are interested in purchasing the full traumatic fracture chart reference, please email suzanneb@codinginstitute.com with “Fracture Chart” in the subject line.