Wiki Osteoporosis in the 'problem list'

LuckyLily

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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.
 
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.
 
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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