# Help me!  Infected non union fracture.



## Shrina (Sep 15, 2011)

:confusedI need ICD 9 for an infection nonunion fracture of the shoulder.  The cause is enterococcol bacteria.


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## Jenatsky (Sep 15, 2011)

*Nonunion of Fx*

733.82 Nonunion of fracture
Here is some add'l info to assist you from coding clinic and you may consider a V code for the infection if that is appropriate.

Malunion vs. nonunion of fracture - guidelines 
Coding Clinic, Second Quarter 1994 Page: 5 
Effective with discharges: April 1, 1994       

Malunion versus Nonunion

 "Malunion" (code 733.81, Malunion of fracture) implies that bony healing has occurred but the fracture fragments are in poor position. Treatment of a malunion, in general, involves the surgical cutting of the bone (osteotomy), repositioning the bone, and usually the addition of some type of internal fixation with or without bone graft. Malunions are frequently diagnosed during a fracture's healing stages. Many malunions may be left without surgical interventions in hopes that the patient will have no functional problems. Surgery usually results from some functional disability or pain as a result of the less than anatomical position of the bones.

"Nonunion" (code 733.82, Nonunion of fracture) implies that no healing has occurred between fracture parts. Treatment of a nonunion, in general, involves opening the fracture, scraping away the intervening soft tissue (usually scar tissue) and doing a partial debridement of the bone end with repositioning of the bone. Usually, some type of internal fixation and bone grafting is also performed. The treatment of a nonunion is more complicated and difficult to perform than treatment of a malunion.


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## armen (Sep 16, 2011)

Shrina said:


> :confusedI need ICD 9 for an infection nonunion fracture of the shoulder.  The cause is enterococcol bacteria.



*Non-Unions *
Although infection and the severity of the bone trauma are important deterrents to normal fracture healing, instability is the most common cause for a non-union. A non-union occurs when a bone does not heal within six to nine months after a break or fracture. There are several reasons why bone fractures or bone trauma may not heal, including:

Inadequate blood flow 
Infection
Inadequate stabilization after the break/fracture
There are risks of a non-union with any broken bone; however, certain areas like the ankle, shin and hip are more susceptible due to the poor blood flow to these bones. Treatment options for these bone fractures offered at our Southern California practice include surgery to not only freshen and stabilize the fracture, but also to improve the blood flow to the area to augment healing.

I probably would code it as *733.82*Nonunion of fracture + *730.81*	Other infections involving bone diseases classified elsewhere, shoulder region + *041.04*Streptococcus infection in conditions classified elsewhere and of unspecified site, group D [Enterococcus]


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## mmpratt (Sep 17, 2011)

Good info.

Does anyone have specific guidelines as to the time frame for non-union.  One of my docs said something about 6 months for non-union but I couldn't find anything specific about this.

Thanks


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