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This month, we’re focusing on coding fractures to the highest specificity by defining the types of fractures and reviewing the use of the 7th alpha character in ICD-10 to identify the episode of care.

Types of Fractures Description
Open Fracture Also known as a compound fracture, this is when the bone breaks through the skin.
Closed Fracture Also known as a simple fracture, this is when the bone breaks, but there is no open wound to the skin.
Complete When the bone breaks into 2 or more parts.
Incomplete When the bone cracks, but does not break all the way through.
Stress When the fracture is a hairline crack
Displaced When the bone breaks into 2 or more parts and moves so that the 2 ends are not lined up straight.
Non-Displaced When the bone either cracks or breaks all the way through, but does not move and maintains its proper alignment.
Pathological When the fracture is caused by a disease that weakens the bones.
Routine Healing When the fracture has healed as expected in an appropriate amount of time.
Delayed Healing When an appropriate amount of time has elapsed, and the fracture has not healed, but there is still a reasonable expectation that the fracture will heal.
Nonunion When a fractured bone fails to heal after an extended recovery period. These can be a result of delayed healing.
Malunion When a fractured bone heals in an abnormal position.

Note: If documentation does not indicate the fracture as displaced or non-displaced, it should be coded as displaced. A fracture not documented as open or closed should be coded as closed.

ICD-10 includes laterality and a 7th alpha character depicting:

7th Alpha Character Description
A – Initial Patient is receiving active treatment for the fracture. Examples of active treatment include:

  • Surgical
  • Emergency room encounter
  • Evaluation
  • Treatment by a new physician
D – Subsequent Encounters for care after the patient has completed active treatment for the fracture and is receiving routine care for the fracture during the healing or recovery phase. This includes:

  • Cast changes or removal
  • Removal of internal or external fixation device
  • Medication adjustments
  • Surveillance while the fracture heals
S – Sequela Reports the after effects, late effects, and other adverse conditions that occur after the healing and recovery phase of the injury.

When reporting sequela, 2 codes are needed:

  • The specific sequela is sequenced first
  • The injury code is sequenced second with the 7th character S

Note: The 7th character “S” is only added to the injury code, not the sequela code.


ICD-10 Code Description
M21.751 Unequal limb length (acquired), right femur
S72.331S Displaced oblique fracture of shaft of right femur, sequela

If you have any questions, email


ICD-10-CM Optum 2015 ICD-10-CM expert for physicians
Optum 2015 detailed instruction for appropriate ICD-10-CM coding
American Academy of Orthopedic Surgeons