Part B Insider (Multispecialty) Coding Alert

Reader Questions:

Focus on Bone, Not Joint, for 'Fracture'

Question: Is there a diagnosis code for an SI joint fracture?

Answer: Not exactly. A patient can fracture a bone, but not a joint, so you need to check the documentation for the precise bone or bones involved.

For a "sacroiliac (SI) joint fracture" consider the following possibilities: A sacral fracture at the SI joint (806.6x, Fracture of vertebral column with spinal cord injury; sacrum and coccyx, closed; or 805.6, Fracture of vertebral column without mention of spinal cord injury; sacrum and coccyx, closed) a fracture of the ilium (808.41, Fracture of pelvis; other specified part, closed; ilium).

Before you report this, however, you should check to make sure that this is a true fracture and not a stress fracture because this distinction can change your diagnosis coding. If this is a stress fracture, you'll report 733.95 (Stress fracture of other bone) as well as an external cause code, if possible.

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