Home Health ICD-9/ICD-10 Alert

Question: Our patient fell and was hospitalized for a lumbar compression fracture. She also has osteoporosis, which the physician states caused the fracture. We will be providing aftercare. How should we code for her? Must we list an E code for the fall?

Michigan Subscriber

Answer: If you have any questions about a fracture you suspect is pathologic, be sure to consult the physician.

In your case, the physician has documented the link between the osteoporosis and the pathologic fracture. So, your principal diagnosis in M1020a for this patient is V54.27 (Aftercare for healing pathologic fracture of vertebrae) to indicate the aftercare your agency is providing.

Across from the M1020a diagnosis, in M1024, put the code 733.13 (Pathologic fracture of vertebrae). Although the pathologic fracture is a case mix code, it rarely earns points as an Ortho 2 case mix diagnosis. Remember, coding guidelines restrict reporting fracture codes to settings providing active treatment; so these codes cannot appear in M1020 or M1022.

Next, code for the patient's osteoporosis with 733.00 (Osteoporosis, unspecified). You need to include the osteoporosis code because V54.27 doesn't include any information about the patient's osteoporosis.