Orthopedic Coding Alert

Question: Our orthopedist saw a patient in the emergency department for a gunshot wound and diagnosed a metacarpal fracture. He irrigated the site and removed a foreign body. Can we also report a fracture code even though he didn't manipulate the fracture?

Oregon Subscriber

Answer: If the documentation lists the fracture as a diagnosis (815.xx, Fracture of metacarpal bone[s]), you can code fracture care along with irrigation 20103 (Exploration of penetrating wound [separate procedure];extremity). If the notes document debridement, you might be able to report 11012 (Debridement including removal of foreign material associated with open fracture[s] and/or dislocation[s]; skin, subcutaneous tissue, muscle fascia, muscle, and bone) instead of 20103.

Watch out: When dealing with a contaminated wound, definitive fracture fixation would likely be delayed until the immediate threat of infection passes. Because of this, don't automatically submit a closed fracture treatment code unless you have more information to guide your choices. Report a code for closed treatment without manipulation such as 26600 (Closed treatment of metacarpal fracture, single; without manipulation, each bone) unless the fracture required additional treatment while performing the open debridement