Anesthesia Coding Alert

Top tip: Teach providers to document side and type to avoid ‘unspecified’.

When your anesthesia provider is involved in a case to repair a closed femur neck fracture, you currently have only one code option for an unspecified fracture: 820.8 (Fracture of unspecified part of neck of femur, closed). You’ll still have a category for unspecified fractures when ICD-10 becomes effective, but coding won’t stay as simple. Use this walk-through to learn how to assign the correct femoral neck fracture code after October 2014.

1. Watch Your Extra Code Digits

For ICD-10 coding, you’ll begin with category S72.00 for an unspecified fracture of the femoral neck. Then you’ll drill down to assign the correct sixth and seventh digits of the code.

The sixth digit will specify whether the patient has a fracture of the right (1) or left (2) femur, or if the location is unspecified (9). If the fracture is bilateral, report the code twice.

The seventh digit will specify the stage of the encounter (initial, subsequent with routine healing versus delayed healing versus nonunion and malunion, and sequelae).

Note: If both femurs are fractured, you won’t report the same code twice -- you’ll report two different codes. "The sixth digit would be ‘1’ for an unspecified fracture of the neck of the right femur while for the left femur it would be ‘2’," says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, Coder on Call, Inc., in Milltown, N.J., and orthopedic coding division director for The Coding Network, LLC, in Beverly Hills, Ca.

2. Remember the 7th Digit Makes All the Difference

The seventh digit classification (for the stage of the encounter) revamps how you’ll report femur fractures in ICD-10.

Important: The seventh digit classification will remove codes you might be accustomed to including on these claims. You won’t need to add the follow-up V codes, the 900 series late effect codes, the 733.81 (Malunion of fracture), or 733.82 (Nonunion of fracture) for nonunion and malunion, explains Ruby O’Brochta-Woodward, BSN, CPC, CCS-P, COSC, ACS-OR, compliance and research specialist for Twin Cities Orthopedics, P.A. The extra digit also will give you the ability to code for a delayed union, says Woodward.  

Difference: ICD-9 includes options for follow-up visits, nonunion, malunion, and sequelae, but these are more generic codes and are not directly tied to the specific fracture type. There is currently no coding option for a delayed healing.

3. Verify the Fractured Side

Under ICD-10, check the anesthesiologist’s or surgeon’s notes to learn whether the fracture is on the right or the left side.

Depending on that answer, you’ll report either S72.001A (Fracture of unspecified part of neck of right femur; initial encounter for closed fracture) or S72.002A (… initial encounter for closed fracture).

If however, the anesthesiologist (or surgeon) fails to document the fracture side, you’ll report S72.009A (Fracture of unspecified part of neck of unspecified femur; initial encounter for closed fracture). This is not a recommended option, as it could be a possible method for insurance denials, according to Bill Mallon, MD, former medical director of Triangle Orthopedic Associates, in Durham, N.C.

4. Pinpoint the Type of Fracture

Your last consideration when coding these cased under ICD-10 will be the type of fracture (see Table 1). The ICD-10 scenario for an unspecified open fracture of the femoral neck will be very similar to that for the closed fracture, Woodward says. This is another change from ICD-9, which includes only one code option (820.9, Fracture of unspecified part of neck of femur; open). Here are two important points to remember:

The sixth digit option will be the same for the open as the closed fracture, specifying laterality.

The seventh digit will include the same options as those for the closed fracture. However, you’ll also need to know the classification of the open fracture for each stage of the encounter except the sequelae (using the Gustillo classification).  In ICD-9, the coder has only one code option, 820.9.

Reporting codes such as 820.9 that include the word "unspecified" as part of their definition are starting to draw denials as payers seek greater specificity in physician reporting before they will pay a claim, says Stout.

If you don’t find documentation of the side of the open fracture of unspecified part of neck of femur, you’ll report code S72.009B (Fracture of unspecified part of neck of unspecified femur, initial encounter for open fracture type I or II) for type I and II fractures and code S72.009C (Fracture of unspecified part of neck of unspecified femur, initial encounter for open fracture type IIIA, IIIB, or IIIC) for type III fractures.

Bottom line: Make sure you have complete documentation of the procedure. It will be imperative for the provider to document laterality, whether the visit is an initial or follow up visit, and if there are any complications related to the fracture, says Woodward.  If the current problem is a result of a previous fracture (i.e. sequelae of the fracture), the provider also must document that as well as the specifics of the fracture type. Additionally, they will need to document the open classification of the fracture and not merely document that it is an open fracture.