Wiki Unspecified vs. other

[Ash82]

When is it appropriate to use unspecified vs. other? Example, the orthopedic surgeon simply documents distal radius fracture. There is no code for distal radius fracture, other than unspecified. If they don't document that it's an intra-articular, extra-articular, etc.... would it be appropriate to choose the "other specified" or should I use unspecified since the physician knew a more specific diagnosis but simply didn't document it?

 

[CodingKing]

When you pick Other you are saying "Hey ICD-10 committee, this type of fracture is so specific that nothing else captures it and it needs its own code." When you pick unknown it means your doctor has no idea what bone is broken or just says generic "wrist fracture". I think any doctor would have a hard time arguing they don't know what bone is broken in the wrist, unless they never looked at the x-ray or a radiology report. Unless the physician has just made a scientfic dicovery of a new bone in the wrist i cant see any reason why Other would be appropriate.


Code(s) Description
S52.501A ‑ S52.509S S52.50 Unspecified fracture of the lower end of radius
S52.511A ‑ S52.516S S52.51 Fracture of radial styloid process
S52.521A ‑ S52.529S S52.52 Torus fracture of lower end of radius
S52.531A ‑ S52.539S S52.53 Colles' fracture
S52.541A ‑ S52.549S S52.54 Smith's fracture
S52.551A ‑ S52.559S S52.55 Other extraarticular fracture of lower end of radius
S52.561A ‑ S52.569S S52.56 Barton's fracture
S52.571A ‑ S52.579S S52.57 Other intraarticular fracture of lower end of radius
S52.591A ‑ S52.599S S52.59 Other fractures of lower end of radius

 

[Cheezum51]

CMS has basically told all of the carriers that, as of October 1, 2016, unspecified codes are no longer acceptable, with rare exception. I don't have the exact wording of the instructions, but CMS said that unspecified codes could be denied for payment and that carriers and auditors should instruct providers as to the appropriate specific codes to use.

I would definitely agree with what Coding King said above re "other" codes as well.
Tom Cheezum, O.D., CPC

 

[cliff.chen89]

When you pick Other you are saying "Hey ICD-10 committee, this type of fracture is so specific that nothing else captures it and it needs its own code." When you pick unknown it means your doctor has no idea what bone is broken or just says generic "wrist fracture". I think any doctor would have a hard time arguing they don't know what bone is broken in the wrist, unless they never looked at the x-ray or a radiology report. Unless the physician has just made a scientfic dicovery of a new bone in the wrist i cant see any reason why Other would be appropriate.


Code(s) Description
S52.501A ‑ S52.509S S52.50 Unspecified fracture of the lower end of radius
S52.511A ‑ S52.516S S52.51 Fracture of radial styloid process
S52.521A ‑ S52.529S S52.52 Torus fracture of lower end of radius
S52.531A ‑ S52.539S S52.53 Colles' fracture
S52.541A ‑ S52.549S S52.54 Smith's fracture
S52.551A ‑ S52.559S S52.55 Other extraarticular fracture of lower end of radius
S52.561A ‑ S52.569S S52.56 Barton's fracture
S52.571A ‑ S52.579S S52.57 Other intraarticular fracture of lower end of radius
S52.591A ‑ S52.599S S52.59 Other fractures of lower end of radius

So going back to Ash82's question, do you mind clarifying if ICD10 code "S52.501A" would be acceptable to report if the Medical documentation simply states "right distal radial fracture" since as per the example you gave :

When you pick unknown it means your doctor has no idea what bone is broken or just says generic "wrist fracture". I think any doctor would have a hard time arguing they don't know what bone is broken in the wrist,

That the Dr is specifying that its the distal radius in the wrist and not simply just a NOS wrist fx, or would the Dr have to further clarify what kind of fracture to match (e.g that its either a torus fx, colles, smiths, bartons, or none of the above(other/NEC)) for the ICD10 dx code to be acceptable?

 

[CodingKing]

So going back to Ash82's question, do you mind clarifying if ICD10 code "S52.501A" would be acceptable to report if the Medical documentation simply states "right distal radial fracture" since as per the example you gave :
That the Dr is specifying that its the distal radius in the wrist and not simply just a NOS wrist fx, or would the Dr have to further clarify what kind of fracture to match (e.g that its either a torus fx, colles, smiths, bartons, or none of the above(other/NEC)) for the ICD10 dx code to be acceptable?

It really should be queried since type of fracture is always important. if you cant query, S52.501A (Unspecified fracture of the lower end of right radius, initial encounter for closed fracture) since that is far as you can get anatomy wise without knowing the type of fracture. It will never be NEC or Other unless type and location is specified in the record but a code doesn't exist in the book.

Unspecfied = documentation (or providers) fault
NEC or Other = books fault.