# Open fracture resulting from a crush injury



## rizzo9 (Nov 19, 2010)

I recently had a medical record where the patient crushed their finger at work which resulted in an open fracture to the middle finger.  I coded the crush injury as the first dx with the open fracture listed second and the open wound as the third code...is that correct?  I was told that i should code the fracture first but I disagree with that.  Any advice would be very helpful!!!
Thanks


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## sam_son  (Nov 19, 2010)

*Principle Diagnosis*

Hi,

While selecting principle diagnosis ,As per ICD guidlines- that principle diagnosis should be the circumstances of the admission, the therapy provided, the tabular list or the Alphabetic index indicate otherwise. ( In page #26 of ICD book 2010)

In your scenario the therapy is going to be provided for Fracture only , example fracture care will be given . So my opinion also to code Fracture as primary. 
Please tell us for what reason you are disagree with giving fracture as primary. Still giving cursh injury as a primary diagnosis is not going to be a great error.

Thanks


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## rizzo9 (Nov 19, 2010)

Thanks for your response! 

To answer you question, I initially was going to code the fracture but when I looked up the code (Page 287 in ICD 2010 and page 281 in ICD 2011) it has a tip listed.  It states that if phalangeal fracture(s) are due to crushing injury, sequence that code (927.3) first.  Is that not something I should follow?  Also BWC on this claim will allow codes 927.3 816.02 and 883.0 and the injury clearly states this to be an open fracture (816.12).



Thanks again!


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## sam_son  (Nov 20, 2010)

Hi

I agree with you , Now only i am looking that guidline in the book . We need to give Crush injury first followed by Phalanx fracture, if the fracture is due to crush injury.

Thanks for updating me


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