ED Coding and Reimbursement Alert

Knowledge of terms can make coding less confusing

Fracture care and orthopedic procedures are common ED presentations, but there are many different kinds of fractures several with more than one descriptive name. Unless you are fluent in Latin or Greek you may need help understanding some of the terms used to describe the nature of the injury and the corresponding procedure code for reporting.

Consider this example of a burst fracture: An 11year-old male is playing hide and seek in a small closet. He is startled and jumps up hitting the top of his head on the low ceiling.He reports that he is suffering from excruciating neck pain. A CT scan of the neck shows a burst fracture of the rung of C1.In other words and to simplify, it’s a vertebral fracture that bursts open from the traumatic injury, says Caral Edelberg, CPC, CPMA, CAC, CCSP, CHC, President of Edelberg and Associates in Baton Rouge, LA and Atlanta, GA.

If you are not familiar with the term “burst fracture” which is also known as a Jefferson fracture, you might not code the service correctly. Especially in orthopedic presentations, a general knowledge of medical and anatomical terminology is helpful in understanding the nature of the procedure that was actually performed. Once you have these terms mastered, you’ll have a clearer picture of exactly what your physician is doing, and you’ll be able to code it correctly she adds.

Frequently used terms related to fractures and other orthopedic presentations include:

• Avulsion — In some instances, the attachment of a tendon or ligament to the bone is strong enough to cause a piece of bone tear away from the rest the bone, usually in a joint.
• Burst — A specific type of vertebral fracture, which is more severe than a compression fracture. In this type of fracture, fragments are forced posteriorly toward the spinal canal.
• Butterfly — An extra bone fragment seen in comminuted fractures, which is often shaped somewhat like a butterfly.
• Chip — This refers to a small piece of bone usually near a joint or condyle.
• Comminuted — A fracture with more than two fracture fragments. Usually this type of fracture is traumatic in nature.
• Complete — The fracture involves the entire bone cortex.
• Compression — Seen in vertebral body fractures where the cancellous bone is compressed.
• Depressed — When a bone that is part of the fracture is pushed down below the level of the skull or joint it is related to, then this is considered depressed.
• Displaced — In some cases the bone fragments of a fracture are moved apart from each other and this is considered displaced.
• Epiphyseal — A fracture of the epiphysis and physis, or growth plate.
• Greenstick — This type of fracture is always found in children and is an incomplete fracture leaving a partial break that is often angulated.

             Hairline — These fractures represent a crack in the bone that is not complete.
             Impacted — A fracture in which one broken end is wedged into the other broken end.

• Segmental — Multiple fractures on the same bone in which several large pieces of bone have broken away from the bone.
• Spiral — This is also referred to as a “torsion” fracture as the bone ends of the fracture are spiral shaped. Usually seen in long bones.
• Stress — A crack in the bone, often from excessive physical exertion. This will show up on later radiographs after callus formation begins, but may not be noticeable on initial radiograph. Also termed an “insufficiency fracture.”