Anesthesia Coding Alert

‘Open’ or ‘closed’ won’t be good enough documentation under ICD-10.

When you report anesthesia during a surgical case to repair bimalleolar ankle fracture, be prepared to dig for more details once ICD-10 goes into effect.

Difference: Currently, you’re accustomed to documenting closed or open fractures under ICD-9. Your provider (or the surgeon) will need to include additional details when following ICD-10 so that you can report the most specific fracture code. A quick review of coding for a closed bimalleolar fracture is a helpful introduction to what’s in store when ICD-10 becomes effective in October of next year.

Diagnosis: A bimalleolar fracture indicates the patient fractured two malleoli. “Bi-” means two, and malleoli are the bony protuberances on the sides of the ankle. So if documentation shows the patient fractured the lateral and medial malleoli, the patient has a bimalleolar fracture. A closed fracture means the fracture did not break through the skin.

ICD-9-CM Code:

• 824.4, Bimalleolar fracture closed

ICD-10-CM Codes:

• S82.841A, Displaced bimalleolar fracture of right lower leg, initial encounter for closed fracture
• S82.842A, Displaced bimalleolar fracture of left lower leg, initial encounter for closed fracture
• S82.843A, Displaced bimalleolar fracture of unspecified lower leg, initial encounter for closed fracture
• S82.844A, Nondisplaced bimalleolar fracture of right lower leg, initial encounter for closed fracture
• S82.845A, Nondisplaced bimalleolar fracture of left lower leg, initial encounter for closed fracture
• S82.846A, Nondisplaced bimalleolar fracture of unspecified lower leg, initial encounter for closed fracture

ICD-9 coding rules: ICD-9 includes a single bimalleolar closed fracture code, 824.4, in the 824.x range (Fracture of ankle). Dupuytren’s fracture is also coded to 824.4.

ICD-10 changes: ICD-10 divides bimalleolar closed fracture coding into multiple S82.84- options. Note that ICD-10 indexes Dupuytren’s fracture to the S82.6- range (Fracture of lateral malleolus).

Documentation: To help you choose among the more specific ICD-10 codes for a bimalleolar closed fracture, be sure to let the physician know you’ll need documentation of whether the fracture is displaced or nondisplaced and which leg is involved. You also may have noticed the code definitions include the phrase “initial encounter.” The “A” used as the seventh character in the codes represents “initial encounter.” For a closed fracture in the S82.- range, you’ll choose from these options:

• A, initial encounter for closed fracture
• D, subsequent encounter for closed fracture with routine healing
• G, subsequent encounter for closed fracture with delayed healing
• K, subsequent encounter for closed fracture with nonunion
• P, subsequent encounter for closed fracture with malunion
• S, sequela.

Coder tips: You may not always have all the information you need, so be sure to apply these coding guidelines listed for the S82.- range:

A fracture not indicated as displaced or nondisplaced should be coded to displaced

A fracture not indicated as open or closed should be coded to closed.

Remember: CMS has finalized the ICD-10 compliance date of Oct. 1, 2014. When ICD-10 goes into effect, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and at www.cdc.gov/nchs/icd/icd10cm.htm#10update.