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Fracture Coding with 7th Character Extenders
With the implementation of ICD-10-CM, coding for fractures will require an in-depth knowledge of the patient's course of treatment. ICD-10-CM will require more precise location choices, laterality, episode of care, and indication as to the healing process of the fracture. ICD-10-CM indicates that a fracture not indicated as open or closed should be coded to closed (which is the same as ICD-9-CM currently reads). ICD-10-CM also indicates that a fracture not indicated whether displaced or non-displaced should be coded to displaced (ICD-9-CM does not specifically state this).
7th character extenders are utilized for fracture code assignment in ICD-10-CM to indicate the encounter. The encounter denotes where the patient is in the treatment cycle: initial, subsequent, or sequel (late effect). In some cases there are 16 choices for the 7th character extenders for a fracture. When you look at the choices in detail, you can see that it is a major improvement to the process of coding the patient's diagnosis. For instance, when coding for traumatic fractures, the initial visit by the provider will require the "initial encounter" 7th character extender to indicate the patient is receiving active medical treatment for their condition:
A - initial encounter for closed fracture
B - initial encounter for open fracture type I or II initial encounter for open fracture NOS
C - initial encounter for open fracture type IIIA, IIIB, or IIIC
Initial encounters include first visits, evaluation by a new provider, and surgical intervention.
When the patient returns for subsequent visits, it will be necessary to indicate his or her healing process with the appropriate 7th character, including:
D - subsequent encounter for closed fracture with routine healing
F - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
H - subsequent encounter for open fracture type I or II with delayed healing
K - subsequent encounter for closed fracture with nonunion
R - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
These 7th character extenders are used to indicate the patient has completed active medical treatment and is receiving routine care during the healing or recovery phase. The 7th character extender S is used to indicate a sequela, or late effect has occurred.
While code assignment for fractures may take a little longer with ICD-10-CM, more precise, detailed code assignment will lead to faster claim adjudication and fewer record requests.
IN THE NEWS
CMS, through Medscape Education, has released two free ICD-10 video lectures and an expert article providing practical guidance for the ICD-10 transition. The video lectures are specifically for physicians, while the article covers more general topics for all health care providers.
SUBJECTIVE: This 27-year-old white female presents with complaint of seasonal allergies. She used to have allergies when she lived in Seattle but she thinks they are worse here. In the past, she has tried Claritin and Zyrtec. Both worked for short time but then seemed to lose effectiveness. She has used Allegra also. She used that last summer and she began using it again two weeks ago. It does not appear to be working very well. She has used over-the-counter sprays but no prescription nasal sprays. She does have mild asthma but does not require daily medication for this and does not think it is flaring up. She has not had to use her rescue inhaler, nor does her asthma wake her at night. Patient is a former cigarette smoker at 1 pack per day. She quit 3 years ago.
ALLERGIES: She has no known medicine allergies.
OBJECTIVE: Vitals: Weight was 130 pounds and blood pressure 124/78.
HEENT: Her throat was mildly erythematous without exudate. Nasal mucosa was erythematous and swollen. Only clear drainage was seen. TMs were clear. Neck: Supple without adenopathy. Lungs: Clear.
ASSESSMENT: Seasonal allergic rhinitis.
1. She will try Zyrtec instead of Allegra again. Another option will be to use loratadine.
2. Samples of Nasonex two sprays in each nostril given for three weeks. A prescription was written as well.
J30.2 Other seasonal allergic rhinitis
J45.20 Mild intermittent asthma, uncomplicated
Z87.891 Personal history of nicotine dependence
Rationale: In ICD-10-CM, allergic rhinitis needs to include type for the most specific code assignment. There is an instructional note at the beginning of Chapter 10, Diseases of the Respiratory System, to include codes for exposure to tobacco smoke, history of tobacco use, and tobacco use or dependence. Codes for asthma in ICD-10 should contain the type (intermittent or persistent); whether it is mild, moderate, or severe; and whether it is uncomplicated, with exacerbation, or with status asthmaticus. In the above scenario, the patient's asthma is stated as mild. They do not use a rescue inhaler and the asthma does not awaken them at night, constituting intermittent, uncomplicated asthma. It is also stated that the patient is a former smoker; therefore, a personal history of nicotine dependence is also reported.
ICD-10 IMPLEMENTATION STRATEGIES
We will be sharing a number of strategies to help your practice successfully implement ICD-10-CM. Please remember to track your progress in your ICD-10 Implementation Tracker on AAPC's website.
To assess the overall needs for your practice, an impact assessment will provide a gauge of where your practice/facility stands in regards to ICD-10. It can be done in the form of a survey, asking employees their department, what they know about ICD-10, if they have received any training already on ICD-10, and how they think it will affect their department. This will give an overall snapshot of where the practice currently is, enabling you to figure out where you need to start your transition and how you may need to allocate resources. It may also give you an idea of people that may be good fits for some of the ICD-10 committees.
AAPC has produced this white paper as a complimentary resource. The intent is to educate readers on the history of ICD-10, the benefits it will provide, the projected impact it will have on our health system, and suggestions on how to have a successful ICD-10 implementation.