ED Coding and Reimbursement Alert

Question: A patient came into the ED with multiple fractures. How do I know which one to report first?


Nebraska Subscriber  
Answer: When the physician treats patients with more than one fracture, you should first check to see whether any of the fractures are open or complicated by debris. If so, you'll need to list that fracture as the primary diagnosis. If no fractures fit that description, you should code the fracture of the longest or largest bone first.
For example, if a patient has fractured both his femur and one of his fingers, you would report the femur break first with a code from the 820.x (Fracture of neck of femur) or 821.x (Fracture of other and unspecified parts of femur) series, and then the appropriate 816.x (Fracture of one or more phalanges of hand) series code for the finger. If there aren't significant differences between the sizes of the fractured bones or their complications, you should report first whichever fracture required the most work from the emergency department physician.