# fracture coding for osteoporosis



## Dneely (Mar 1, 2016)

Hello,
  I wanted to know if anyone was familiar with coding fractures for patients that has osteoporosis. I listened to an audio conference and was told my physician has to link the pathologic fracture to osteoporosis. When I go to the coding guidelines, it states osteoporosis is a systemic condition that affects all the bones of the musculoskeletal system. It goes on to say that a code form the M80 category not a traumatic fracture code should be use for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone.  It does not state the pathologic fracture needs to be linked to osteoporosis. My physician is performing a kyphoplasty after a patient has presented to ER after a fall that caused a fracture. He never indicates that the pathologic fx is linked to osteoporosis but if I am reading correctly, the fx should be coded with the M series and not an S series.


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## mitchellde (Mar 1, 2016)

If you can make the judgement that the fall would not have fractured a healthy bone.  If you do not have enough information about the fall or cannot decide then you need to query the provider.  The guideline does not say it is automatic as a pathological fracture, it states if the fall or trauma would not have fractured a healthy bone.


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## Dneely (Mar 1, 2016)

mitchellde said:


> If you can make the judgement that the fall would not have fractured a healthy bone.  If you do not have enough information about the fall or cannot decide then you need to query the provider.  The guideline does not say it is automatic as a pathological fracture, it states if the fall or trauma would not have fractured a healthy bone.



Thanks


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## daedolos (Mar 15, 2017)

So it's an either or situation?  Not both, right?

Peace
@_*


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## mdarling (Apr 21, 2017)

*Pathologic Fxs*

When billing kyphoplasty, Medicare has an LCD for NYS.  You can go online and pull the ICD 10 codes.  Not sure about what state you are in for a NCD .


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