ED Coding and Reimbursement Alert

Let these examples of the 7th character extensions for fractures that do not use Gustilo classifications and those that do guide your coding. See the descriptions below.

Category S42

Category S42 (fracture of shoulder and upper arm) does not require Gustilo classifications and the 7th character extensions are as follows:

A  Initial encounter for closed fracture
B  Initial encounter for open fracture
D  Subsequent encounter for fracture with routine healing
G  Subsequent encounter for fracture with delayed healing
K  Subsequent encounter for fracture with nonunion
P  Subsequent encounter for fracture with malunion
S  Sequela

Example: For an emergency room evaluation (initial) and treatment of closed nondisplaced simple supracondylar fracture without intercondylar involvement right humerus, you would report code S42.414A (Nondisplaced simple supracondylar fracture without intercondylar fracture of right humerus, initial encounter for closed fracture).

Category S52

Category S52 (fracture of forearm) does use Gustilo classifications (except for fractures in this category documented as torus or greenstick) and the applicable 7th characters are as follows:

A  Initial encounter for closed fracture
B  Initial encounter for open fracture type I or II
C  Initial encounter for open fracture type IIIA, IIIB, or IIIC
D  Subsequent encounter for closed fracture with routine healing
E  Subsequent encounter for open fracture type I or II with routine healing
F  Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
G  Subsequent encounter for closed fracture with delayed healing
H  Subsequent encounter for open fracture type I or II with delayed healing
J  Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
K  Subsequent encounter for closed fracture with nonunion
M  Subsequent encounter for open fracture type I or II with nonunion
N  Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
P  Subsequent encounter for closed fracture with malunion
Q  Subsequent encounter for open fracture type I or II with malunion
R  Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S  Sequela

Example: A 16 year old male waiter is carrying a heavy tray of food and slips on some grease in the kitchen striking his forearm and elbow on the stove. The physician performs a detailed history and physical exam and provides pain relief with IM Toradol. X-rays show a fracture of the left ulna.  Additional pain control is provided as well as a long arm splint. Arrangements are made for further treatment by an orthopedist the following day for likely casting.

Report 99284 a level 4 ED E/M visit, 29105 (Application of long arm splint [shoulder to hand]) and ICD-10 code below. S52.012A (Torus fracture of the upper end of the left ulna, Initial encounter for closed fracture).