ED Coding and Reimbursement Alert

Question: I am a bit confused. I am looking at a patient's fracture-care encounter form. Notes indicate that the physician fixed a greenstick fracture. I have no idea what that is. Could you help?


South Carolina Subscriber

Answer: When you are coding claims for fracture care, some of the terms you-ll come across for describing the injuries are well-known, such as hairline and stress fractures.

But some terms physicians may use to describe fractures can give a coder pause: Such as a greenstick fracture, which is an incomplete fracture leaving a partial break that is often angulated. (This type of fracture is found exclusively in children.)

Fracture definition reference: Check out this list of common fracture terms, along with a simple explanation for each one:

- Avulsion--In some instances, the attachment of a tendon or ligament to the bone is strong enough to cause a piece of bone to tear away from the rest of 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 can be 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.

- 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. 

- 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.-