Wiki Help with Fracture Diagnosis after Surgery

[abfloyd1]

I have a physician who insists that after the patient undergoes surgery for a fracture, the fracture diagnosis drops and only a pain diagnosis code is used. For example, he did an ORIF for a wrist fracture, but then refuses to include the diagnosis of wrist fracture for claims after the surgery. I know this is incorrect, but cannot find specific guidelines/ rules to prove my point. Can anyone point me to some written guidance I can provide the physician?

 

[mitchellde]

The answer may be in the 7th character that indicates healing fracture. Your provider is is correct in that it is not a fracture any longer but it is a healing fracture and that is why the 7th character was created, it changes the code from an active fracture to one that is now healing. Since pain is an inherent part of the healing process it is part of the healing fracture. If the pain is more than what is normal associated then you can add the g89 code for acute pain due to trauma if supported by the documentation.