Podiatry Coding & Billing Alert

Question: I am not sure if I understand the difference between traumatic, stress, and pathological fractures and the importance of knowing this when reporting ICD-10 codes. Can you please explain?

Alaska Subscriber

Answer: When you are reporting fractures, it’s vital to look at the documentation and see what type of fracture the patient has because your ICD-10 coding choices will be different.

Traumatic: For example, a patient was in a car accident and suffered from a closed, displaced fracture of his medial malleolus in his right tibia. A fracture is considered traumatic when it is caused by some type of accident, fall, or other kind of force, such as when a heavy object strikes a patient. For traumatic fractures for podiatry patients, you would look to S82- (Fracture of lower leg, including ankle) and S92- (Fracture of foot and toe, except ankle).

Example: For this particular example, for the initial encounter, you would report S82.51XA (Displaced fracture of medial malleolus of right tibia, initial encounter for closed fracture).

Stress: On the other hand, stress fractures are tiny cracks in the bone caused by repetitive stress or force, often from overuse. These often occur in normal or metabolically weakened bones.

Example: According to the documentation, the podiatrist diagnoses the patient with a stress fracture in his left toe, initial encounter. You would report M84.378A (Stress fracture, left toe(s), initial encounter for fracture).

Pathological: A pathological fracture is a broken bone that’s caused by a disease, rather than trauma. If reporting a pathological fracture, it is absolutely necessary to make sure the documentation states the underlying cause of the disease.

Example: The patient, who has age-related osteoporosis, suffers from a current pathological fracture of her left ankle. This is a subsequent encounter with delayed healing. You would report M80.072G (Age-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with delayed healing).