FracturesAugust 19, 2016
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:
|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:
|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:
Note: The 7th character “S” is only added to the injury code, not the sequela code.
|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 CodingCounts@healthalliance.org.
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