Home Health ICD-9/ICD-10 Alert

Question: A patient fell and now has a lumbar compression fracture, for which she was hospitalized. The patient also has osteoporosis, which probably contributed to the fracture. Would we use the code for a fracture caused by osteoporosis or some other code to explain why she now needs home care? Would we use an E code for the fall?

Answer: You'd need a bit more information about the fracture to code the scenario correctly. You must determine whether the compression fracture is actually pathological, notes Sue Bowman, RHIA, CCS, director of coding policy and compliance for the American Health Information Management System.

Keep in mind that some compression fractures are traumatic, she notes. Therefore, you'd need to clarify with the physician whether the fracture was caused by the fall (traumatic) or caused by the osteoporosis (pathological).

Assuming that the fracture is pathological, and that she's been admitted to home care for aftercare related to that fracture, you would code both the compression fracture and the aftercare you're providing for that fracture.

First, use V54.27 (Aftercare for healing pathologic fracture of vertebrae) to indicate the aftercare your agency is providing. Then code for the fracture 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, notes Bowman.

"Pathological fractures can be caused by a number of conditions, not just osteoporosis," Bowman explains. For example, the patient could have had a neoplasm, she offers.

Don't: You should not use code 733.13 (Pathologic fracture of vertebrae), notes Bowman. "An aftercare code should not be reported in conjunction with an acute fracture code," she reminds coders.

If you have room, use the appropriate E code to describe the patient's fall (you'd need more information about the fall to determine the exact code).