Orthopedic Coding Alert

ICD-10:

Adopt These New Atypical Fracture Diagnoses Starting October 1

Published on Tue Jun 28, 2016

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Check out the evolution of this unique terminology.

If you are baffled by the term “atypical fracture,” then you are not alone. Many orthopedic experts have been scratching their heads, but here’s what you need to know – before you start using these codes October 1.

First, Familiarize Yourself With the New Codes

Here are the new “atypical fracture” codes coming your way:

M84.750- — Atypical femoral fracture, unspecified …
M84.751- — Incomplete atypical femoral fracture, right leg …
M84.752- — Incomplete atypical femoral fracture, left leg …
M84.753- — Incomplete atypical femoral fracture, unspecified leg …
M84.754- — Complete transverse atypical femoral fracture, right leg …
M84.755- — Complete transverse atypical femoral fracture, left leg …
M84.756- — Complete transverse atypical femoral fracture, unspecified leg …
M84.757- — Complete oblique atypical femoral fracture, right leg, …
M84.758- — Complete oblique atypical femoral fracture, left leg …
M84.759- — Complete oblique atypical femoral fracture, unspecified leg …

You’ll apply a seventh character to these codes from the following list:

A – initial encounter for 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

Example: If your orthopedic physician sees a patient for an incomplete atypical femoral fracture of the left leg for a subsequent encounter for fracture with delayed healing, then you would report M84.752G.

Now Go In Depth With This Rationale

The term “atypical fracture” has many seasoned coders asking what that means, and you can find the answer in the ICD-9-CM Coordination and Maintenance Committee Meeting Summary of Diagnosis Presentations for March 5, 2012 (URL: www.cdc.gov/nchs/data/icd/2012_march_summary.pdf).

Elizabeth Shane, MD, representing the American Society for Bone and Mineral Research (ASBMR), explained that the “term atypical femoral fracture is widely accepted in the academic community.”

If your orthopedist uses the term “Fosamax fracture,” then you may refer to an atypical fracture. This kind of fracture “can also happen in some without exposure to bisphosphonates. Clinicians and researches need to be able to track all such atypical femoral fractures,” the committee notes say that Shane adds. “By calling them Fosamax fractures, then a population of patients may be missed, since the fractures can occur in absence of taking these drugs.”

Concerned about your physician not adopting these new terms? Dr. Shane “acknowledged uncertainty about how widespread use of the term would be outside the academic community.” A commenter noted, “… it takes time for terminology to move into regular clinical use from the academic setting.”

“Because they are in Chapter 13, I would think they are non-traumatic fractures that have something to do with osteoporosis or a deficiency of some sort,” says Peggy Stilley, CPC, CPC-I, CPMA, CPB, COBGC, a revenue integrity auditor for OSOI in Norman, Oklahoma.

Remember: “Review of the clinical documentation is always recommended to verify codes can be assigned without use of unspecified codes,” Stilley says. “Best practice would include ongoing clinical documentation improvement, providing feedback to the physician including guidance on capturing the specific data requirements.”