Fracture Coding Tips You Can't Afford to Miss

Helpful reminders to avoid common trip-ups

Fracture care terminology can be confusing, and specificity is crucial to choosing the correct code. Remember these hints to help you straighten out treatments, anatomic sites, and fracture types--and keep your coding in line.

• The type of fracture has no correlation with the type of treatment. The patient can have any combination of open or closed fractures that require open or closed treatment--whether the fracture type is open or closed shouldn’t affect your CPT coding. The type of treatment is what determines the CPT code, while the type of fracture determines the  ICD-9 code.
• You need as much detail as possible about the anatomic site of the fracture or dislocation. For example, the specificity of some fracture treatment codes may require you to know which phalanx in a finger or toe was fractured--middle, proximal or distal. Sometimes you may even need to go a step further, and know whether the distal end, shaft, or proximal end of a particular phalanx was injured.
• If the physician applies a cast or strap, find out the entire scope of treatment. Physicians often fail to give coders enough details about why they apply casts or straps. If the doctor applies a cast or strap and isn’t planning on performing more fracture care on that patient, you can assign codes from the 29000 series. In this case, the physician is performing the treatment solely to protect the fracture and to relieve pain, but he isn’t providing restorative fracture care.

However, if the physician also performs a surgical repair, you’ll probably assign a fracture or dislocation code instead.
• Buddy taping is part of an evaluation and management service. When the emergency department physician tapes one finger to another with the purpose of immobilizing a sprained or fractured finger, you should not report casting/strapping code from the 29000 series--and you definitely shouldn’t report a fracture/dislocation treatment code. Instead, you should assign one of the 99281-99285 series.
Coding tips provided by Lolita M. Jones, RHIA, CCS, an independent consultant specializing in hospital outpatient and ambulatory surgery center coding, billing, and reimbursement, and operations in Fort Washington, Md.

- Published on 2005-10-11