Home Health ICD-9/ICD-10 Alert
Look For Fracture Coding Change Under New PPS
Question: I am confused about fracture codes. When is it appropriate for us to code a fracture itself? And what is the correct aftercare code in these three situations: when the patient had a joint replacement to fix the fracture; when the patient had an ORIF to fix the fracture; and when no surgical treatment was provided for the fracture? -- California Subscriber Answer: It is never appropriate for home care to code a trauma fracture or a pathologic fracture in any OASIS data item that will show up on the claim. Wrong way: That means a trauma fracture or pathologic fracture may not ever be coded in M0230 or any of the M0240s. Right way: You may use trauma fracture codes in M0190, M0210 and M0245. And you may use the pathologic fracture codes in M0190 and M0210. They are not used in M0245 because they are not case mix codes. New way: After Jan. 1, you may place trauma fracture and pathologic fracture codes in M0190, M0210 or M0246 because both kinds of fractures will be case mix codes. The correct aftercare code for the patient who has had a joint replacement to repair a fracture is V54.81 (Aftercare following joint replacement). The V54.1x and V54.2x codes are appropriate for all other fractures regardless of the treatment received. The correct aftercare code for trauma fractures is V54.1x (Aftercare for healing traumatic fracture), and the correct aftercare code for pathological fractures is V54.2x (Aftercare for healing pathologic fracture). Caution: The V54.09 code that some home care coders use for a patient
Home Health ICD-9/ICD-10 Alert
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