# Hardware removal after fracture



## sxcoder1 (Jan 21, 2016)

Just verifying one more time! If patient is having hardware from ORIF removed, I'm just going to use Z47.2 and no fracture code, right?  Patient is not having complications or pain.  Thanks!


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## mitchellde (Jan 21, 2016)

You do not use aftercare Z codes for injury and trauma.  So use the fracture code with a subsequent with routine healing.


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## sxcoder1 (Jan 21, 2016)

Ok, ICD10 is a bit confusing on that.  So I'll use a fx code with a D for this surgical procedure, even though surgery is considered "active" and we usually use "A".   Also in the front guidelines, it does say not to use Z codes for fx aftercare, however under Z47.2 the excludes says "encounter for adjustment of internal fixation device for fx treatment" and "encounter for removal of external fixation device" and doesn't say anything about excluding removal of internal fixation device for fx treatment.  Confusing.


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## mitchellde (Jan 21, 2016)

Not all surgery is active treatment.  That is a misnomer.  And not all fractures are trauma related.  So yes for hardware removal from a trauma fracture you use the D, E, or F seventh character.


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## sxcoder1 (Jan 21, 2016)

Thank you for the clarification on all that.  And I thought I understood it all!


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## bwolfe1 (Jan 21, 2016)

My understanding is that  Z47.2 is to be coded for removal of "internal" fixation devices.  Adjustments of "internal" fixation devices and removal of "external" fixation devices are to be coded to the fracture with 7th character "D".


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## bwolfe1 (Jan 22, 2016)

Thanks. This topic brought up a great conversation in our office. We determined that the official guidelines would supersede any coding notes.  The excludes description under Z47.2 would be more helpful if "removal of internal fixation device" was included instead of just "adjustment of internal fixation". They are specific when describing the "removal of external device".


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## AlanPechacek (Jan 25, 2016)

*Hardware removal*

The real issues at hand, or questions to be answered, are whether the fracture has healed and no longer under the status of "Active Treatment," and why/for what reason is the fixation being removed?  If still under "Active Treatment," as this person does not appear to be, then there would have to be a reason for removal such as a complication for which a T84.1/2/3/4/6/8_ _ _ would be appropriate along with the Fracture Code and the appropriate 7th character (D, etc.)  The history as given for this case implies that the fracture has healed and is no longer under "Active Treatment , which brings up the question as to why the fixation is going to be removed.  This brings up the use of Z Codes.  Z Codes are not diagnosis codes, in and of themselves, but are reasons for encounters.  If the patient is being seen to discuss the hardware removal of a previously well healed fracture without identifiable residual complications or problems, then the Z47.2 code would probably be appropriate, along with Z87.81, Personal History of Healed Traumatic Fracture.
Alan Pechacek, M.D.


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## sxcoder1 (Jan 25, 2016)

To give a little more information, the doctor's note said "patient is doing well, fracture has healed and I recommend removal of the pin."


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