Coding Corner: Don’t Let Your Fracture Care Coding Break Down

Follow these tips for frustration-free claims

If intermediaries are finding fault with your fracture care claims, you can break the pattern by mastering fracture ICD-9 coding and knowing how to distinguish between open and closed fractures. Use these expert tips to make your fracture care coding a snap.

Watch 4th and 5th Digits
Incorrect diagnosis coding is one of the primary reasons for claim denial in fracture care, says Elisabeth P. Fulton, CPC, coding and auditing department supervisor at Orthopedic Specialists of the Carolinas in Winston-Salem, N.C. When coding fractures, you need to be as specific as you can with your diagnosis codes, she adds.
Fracture codes extend to the fourth or fifth digit, depending on the diagnosis. The fourth digit indicates if the fracture is open or closed, while the fifth digit indicates the specific location of the fracture. For example, you would report 812.21 (Fracture of humer-us; closed; shaft of humerus) for a patient with a closed fracture in the shaft of his humerus. The fourth digit 2 indicates “shaft or unspecified part, closed” and the fifth digit 1 shows the more specific location “shaft of humerus.”
Scenario: A 25-year-old male suffers a broken metacarpal shaft in his right hand, a fractured mandible, and a fractured left femur during a highway motorcycle accident. The patient receives closed fracture treatment for each fracture.
You code: Make sure to match the ICD-9 code for each fracture with the appropriate fracture care code, Fulton says. And when you code multiple fractures at one time, report the worst fracture first. Remember that multiple- surgery rules will apply: The payer will reimburse the first procedure at 100 percent, and the second and subsequent procedures at 50 percent of their allowance, says Michelle Logsdon, CPC, CCS-P, CMC, of Cash Flow Inc. in Brick, N.J.

For the above scenario, you might report the following codes:

• 821.01 (Fracture of other and unspecified parts of femur; shaft or unspecified part, closed; shaft) linked to 27502 (Closed treatment of femoral shaft fracture, with manipulation, with or without skin or skeletal traction) for the fractured femur treatment.

• 802.20 (Fracture of face bones; mandible, closed; unspecified site) linked to 21450 (Closed treatment of mandibular fracture; without manipulation) for treatment of the fractured mandible.

• 815.03 (Fracture of metacarpal bone[s]; closed; shaft of metacarpal bone[s]) linked to 26600 (Closed treatment of  metacarpal fracture, single; without manipulation, each bone) for treating the broken metacarpal.

Open Your Eyes to Open Fracture, Closed Treatment
Coders often have problems determining whether a fracture repair is open or closed, Fulton says. They need to understand that an open fracture does not necessarily require open treatment to repair,  Fulton says.
“Coders think that because it’s [...]

- Published on 2006-03-23