Part B Insider (Multispecialty) Coding Alert

Published on Fri Mar 20, 2009 PDF

Know these keywords to select the right ICD-9 code every time.

Myth: Any fracture with more than one break is considered compound.

Reality: Youll know whether your physician treated an open, or compound fracture if the documentation includes the words compound, infected, missile, puncture, open, or with foreign body.

Case closed: Closed fractures refer to fractures in which the skin remains intact, with no broken skin or protruding bone at the site. Look for terms like comminuted,transverse, depressed, elevated,fissured, greenstick,impacted, linear, march, and simple. In addition, most stress fractures are closed fractures.

Tip: Unless the term open or compound appears in the diagnostic statement, you should most likely report a closed fracture code, according to the American Hospital Associations Coding Clinic.

Other terms for closed fractures are common names such as Bennett (an intra-articular fracture at the base of the first metacarpal), Colles (an extension fracture of the distal radius, or wrist), Smith (flexion fracture of the distal radius, or wrist), Tib-fib (fracture of the tibia and fibula), Potts (fracture to the distal fibula), calcaneus (heel bone fracture), clavicle (collarbone), and Holstein-Lewis (spiral fracture to the humeral shaft).

To help you visualize the differences between closed and open fractures, weve created these drawings of two of the most common fractures-- a Colles fracture with an ulnar fracture and a tib-fib fracture.