Osteoporosis in the 'problem list'

LuckyLily

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Local Chapter Officer
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For Risk Adjustment, have you encountered guidance to pick up the osteoporosis that is listed in the 'problem list/past medical history' if in the current encounter the patient comes in for a femur fracture due to fall?

For example, patient presents to ER due to fall. X-ray confirms there is a femur fracture. The provider documents how the patient slipped/fell out of bed. In the 'problem list/past medical history' it has a listing of a previous osteoporotic fracture dx code or just lists osteoporosis.

I've been given guidance that since osteoporosis is listed in the problem list, I can automatically assume and code the current fall fracture as a osteoporotic fracture, not a traumatic fracture. The provider never mentioned anywhere else in the ER note that the patient has osteoporosis.

Would you/do you pick up osteoporosis this way for fractures? I've tried to research this particular scenario, but haven't been able to find anything.

Your guidance would be very helpful. Also, I cannot query the provider to get clarification.
 

Rachel.Sack

Contributor
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Hi, I wouldn’t assume the fracture is due to osteoporosis unless the link is stated. This sounds like a traumatic fracture to me. I would pick up the osteoporosis code and then pick up the traumatic fracture code. You can always query your provider to verify.
 

TThivierge

Guru
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Hi
What is the age of the patient? If over age of 50 years I d use osteoporosis . People are more at risk with osteoporosis fractures as get older. If it is in the patient's past history I d use it too. The dx block M80 list age related. Also read this in the AMA Risk Adjustment Documentation & Coding Manual by Sherri Bernard pg 216-217. Do not forget to add the external dx code of falling out of bed too.
I hope this data helps
Lady T:cool:
 
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