Coding Finger Fractures Doesn’t Have to Be Daunting
Remember the difference between open and closed fractures. Finger fractures are a common orthopedic injury, often resulting from putting out a hand to break a fall, crushing a finger between two objects, working with hand tools or power tools, or striking a hand against or being struck by an object — to name a few. Coding fractures of the fingers can be intimidating. Coders must deal with a total of 14 bones in five digits, open and closed fractures, fractures involving the joint surface, and multiple surgical treatment techniques. Let’s start by unpacking the anatomy of the fingers and types of fractures. Review Finger Anatomy and Fracture Types The index, middle, ring, and little fingers each have three phalanges, while the thumb has only two phalanges. Here’s a breakdown: Common terms surgeons use to describe fracture types include: Look for the following terms that describe specific fracture patterns: Look to the 26720-26756 Codes for Fracture Treatments Orthopedic surgeons treat finger fractures in a variety of ways. Certain types of finger fractures may be treated in a closed manner with taping or splinting, while other more severe fractures may require surgery to realign and stabilize the bone while it heals. CPT® codes for treatment of a finger fracture fall within the 26720-26756 range with codes for closed treatment, percutaneous fixation, and open treatment with or without internal fixation. Closed fracture treatment may be performed with or without manipulation. The term “closed” indicates that the fracture is not surgically opened. Codes for closed treatment without manipulation include: Use the following codes for closed treatments with manipulation: Percutaneous skeletal fixation is a technique that is neither open nor closed. Fracture fragments are not directly visualized, but may be viewed via imaging, and fixation is placed across the fracture site. Below are the percutaneous fixation codes: Open fracture treatment involves surgical exposure and direct visualization of the fracture site with or without internal fixation or placement of an intramedullary device via surgical exposure remote from the fracture site. Assign one of the following codes for an open treatment: Open fracture treatments may require surgical debridement prior to definitive repair. Use a code from 11010-11012 (Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement) …) to report the debridement. Examine These Finger Fracture Coding Examples Let’s code some finger fractures. Example 1: The surgeon diagnoses a patient with a closed displaced intra-articular fracture of the left index finger middle phalanx involving the distal interphalangeal (DIP) joint. The patient undergoes open reduction with the insertion of K wires. ICD-10-CM code: S62.621A (Displaced fracture of middle phalanx of left index finger, initial encounter for closed fracture) CPT® code: 26746 Example 2: A patient’s right little finger is caught in a slamming door, and they sustained an open, displaced distal phalanx fracture. The surgeon performs debridement of the open wound including bone, and then performs percutaneous fixation of the fracture. ICD-10-CM code: S62.636B (Displaced fracture of distal phalanx of right little finger, initial encounter for open fracture) CPT® codes: 26756 and 11012 (Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin, subcutaneous tissue, muscle fascia, muscle, and bone). Heidi Stout, CPC, COSC, President, Coder on Call, Inc.
