ED Coding and Reimbursement Alert

Question: When the ED physician treats multiple fractures, which diagnosis code should I list first on the claim? Our doctor recently treated a patient with the following fractures: closed fracture of the scapula, open fracture to the sternal end of the clavicle, and closed fracture of the pubis. But I don't know which ICD-9 code to list first. Any suggestions?


Washington Subscriber


Answer: You should report the fracture that involved the most treatment as the primary diagnosis on the claim. That means diagnosis coding for any fracture that is open, or complicated by debris, should be listed before you code for closed fractures, or fractures without any debris complications.

On your claim, you should report:

- 810.11 (Open fracture of clavicle; sternal end of clavicle) for the clavicle fracture

- 811.00 (Closed fracture of scapula; unspecified part) for the scapula fracture

- 808.2 (Fracture of pelvis; pubis, closed) for the pubis fracture.

Explanation: When you have two fractures that are equally complicated (or simple), report the fracture for the largest, longest bone first. In your scenario, both the scapula and pelvic fractures were of equal severity, so you should report the scapula fracture first.