Outpatient Facility Coding Alert

Published on Fri Aug 23, 2013 PDF

One key factor could make or break your dx code choice accuracy. 

When your physician treats outpatient knee injuries, you could be befuddled by the elaborate ICD-10 code descriptors for patellar fractures.  As in ICD-9, if you’re zeroing in on whether the fracture is closed or open, you’ll land the right code every time.

Submit Corresponding Code for Closed Fracture

When reporting a closed fracture of the patella, you submit ICD-9 code 822.0 (Closed fracture of patella). The corresponding ICD-10 code is S82.009A (Unspecified fracture of unspecified patella, initial encounter for closed fracture).

Confirm Type in Open Fracture

The ICD-9 code for an open fracture of patella is 822.1 (Open fracture of patella). This has two corresponding codes in ICD-10, S82.009B (Unspecified fracture of unspecified patella, initial encounter for open fracture type I or II) and S82.009C (Unspecified fracture of unspecified patella, initial encounter for open fracture type IIIA, IIIB, or IIIC). You select the appropriate code, depending upon the type of the open fracture, i.e. type I, II, or III. You report code S82.009B for open fracture type I and II, and code S82.009C for open fracture types IIIA, IIIB, and IIIC.

Ensure documentation: Ensure your physician documents the type of open fracture in the clinical note. Failing to do so may lead to underpayments.

Laterality and Morphology Are Not Important

Note that the descriptors of the ICD-10 codes S82.009A, S82.009B, and S82.009C are more elaborate than that of the ICD-9 code 822.0. The descriptors mention ‘Unspecified fracture of unspecified patella.’ This means that you do not need to look at the morphology or the laterality of the fracture.

Key: You report the same code for fracture(s) in both the right and the left patella. Laterality is not important for the ICD-10 codes for a fractured patella, either open or closed. Therefore, codes S82.009A, S82.009B, S82.009C apply to fractures in either the right or the left patella. Similarly, you won’t need to identify the fracture’s morphology — whether transverse, vertical, comminuted, or undisplaced — to accurately select your code.