ED Coding and Reimbursement Alert

See how strong your fracture coding skills might be.

Sometimes it seems like not a day goes by when your ED doesn’t see a fracture patient. Although many of these visits are straightforward, others can be complex when it comes to coding the charts. Check out these three frequently-asked questions, along with answers that will ensure your coding stays on the right track.

What’s the Difference Between Open, Closed Fractures?

Knowing the difference between a closed and open fracture is essential when selecting the most accurate diagnosis codes. A closed fracture involves a break that has not broken the skin. So if there is no evidence of a breach of the skin in the encounter notes, you likely have a closed fracture claim on your hands.

Conversely, an open fracture is when the bone has punctured through the skin or there is a significant break in the skin directly over the fracture site -- not an abrasion or superficial laceration.

As you might surmise, open fractures are usually pretty serious business and will almost always require the services of an orthopedic surgeon. ED practitioners will rarely treat open fractures, as there is significant risk of infection, and open fracture treatment usually requires some type of fixation device.

However, ED physicians do often report E/M codes that involve diagnosing open fractures. Therefore, you can never assume that just because your ED physician diagnoses a fracture that it was a closed fracture. In many cases, the ED physician will order the x-ray and perform the E/M service that results in the open fracture diagnosis before the patient’s care is transferred to a specialist.

How Do You Find the Correct Lateral Malleolus Fracture Code?

Answer: One of the most common fractures seen in the ED is the ankle fracture, and the most frequent ankle fracture involves the lateral malleolus injury. Even though CPT^® directs you to the 27786-27792 series for lateral malleolus fractures, your work may not be done because ED physicians don’t always dictate “lateral malleolus fractures” in their documentation. For instance, your provider may document “distal fibula” fracture instead.

For closed fracture treatment of the lateral malleolus, report either 27786 (Closed treatment of distal fibular fracture [lateral malleolus]; without manipulation) or 27788 (… with manipulation). You would report 27786 for an application of a cast, CAM walker, splint, or orthosis. On the other hand, you would use 27788 when the fracture is displaced and needs to be reduced.

In this case, you’ll report code from the S82 series of ICD-10, such as S82.62XA (Displaced fracture of lateral malleolus of left fibula, initial encounter for closed fracture).

Which Dx Code Describes A Displaced Intertrochanteric Hip Fracture?

Answer: Hip fractures can be traumatic and can present as emergency visits transported via ambulance, or they can be diagnosed when patient simply has chronic pain when they are hairline fractures. When a patient presents with a displaced intertrochanteric hip fracture, you’ll typically report a code from either the S72.141- (Displaced intertrochanteric fracture of right femur), or S72.142- (Displaced intertrochanteric fracture of left femur) listing, depending on which side is affected.

What that means: An intertrochanteric fracture refers to a break in the proximal portion of the femur.