Bone Up on Fracture Treatment Coding: Dont Fall for These Common Errors

Coding for broken bones can get complicated because you have so many questions to address which bone was fractured, the type of break and what treatment option the doctor used and the physician's lingo doesn't always tip you off to the answers. Remember this advice from the experts to simplify the process.

Know Your Bones
 
Choosing a diagnosis code is always easier when you understand basic bone anatomy and the terms that describe it, says Mark Hutchinson, MD, associate professor of orthopedics at the University of Illinois in Chicago. First, you'll need to know which bone was broken. You'll also need to know whether the fracture is open (the skin was broken in addition to the bone) or closed (no skin broken). Refer to the chart below for common terms that will help you determine if the fracture was open or closed.
If the doctor's notes don't specify which type of fracture, "it's probably a safe fall-back" to code it as closed, Hutchinson says. And because there are fewer descriptors for open fractures, remembering those terms and determining when a fracture is closed by process of elimination often is easier. Hutchinson says to keep in mind, though, that if additional risks arise later like infections the open code would better explain that to a critical eye.
 
Once you know the bone and the type of fracture, you need to know which part of the bone was broken. This information may be as simple as "upper," "lower," or "shaft," or it may require more specificity. Keep these four terms in mind when deciding on a fifth digit: condyle, coronoid process, ramus and symphysis. Many coders make the mistake of assuming these terms describe bones, but in fact they refer to particular parts of bones.
Casting: Determine Extent of Treatment
 
There are two major procedures for immobilizing a fractured bone: casting and fixation. Whether you should report the cast application separately is not always a clear-cut decision, and you may need to query the physician to determine whether she put the cast on as part of the restorative treatment or just to make the patient comfortable during the diagnostic process, Hutchinson says.
 
If the physician applies the cast without recommending a full course of treatment for example, if she orders the cast to stabilize the bone and then refers the patient to an orthopedic clinic for a full evaluation you can report the appropriate code from the 29000-29590 series, because the care qualifies as definitive and therefore isn't included in the fracture treatment code. But if she applies a cast as the restorative treatment (rather than just for temporary protection), the application is rolled into the CPT code for [...]

- Published on 2003-07-01