Home Health ICD-9/ICD-10 Alert

Question: I have been taught that fracture codes are for acute care only and cannot be used in the M0230/240 columns. But they can be used in M0246 with the aftercare V code that matches. My colleague, however, argues that fracture codes may be used in the M0230/240 slots. Could you please clarify the correct way to code fractures?

Answer: The official coding guidelines specify that acute fracture codes (800s and 733.1x) are reserved for active treatment. The guidelines go on to specify that active treatment is care provided by the hospital, emergency department, or the physician. The acute fracture codes are not appropriate for home health because we provide aftercare.

Use the aftercare codes in the V54.1x (Aftercare for healing traumatic fracture) series for traumatic fractures and the V54.2x (Aftercare for healing pathologic fracture) codes for pathological fractures regardless of the type of active treatment provided. The only exception to this rule is if the fracture was treated by a joint replacement. In that case, list V54.81 (Aftercare following joint replacement) instead of a V54.1x or V54.2x code.

You may place an acute fracture code M0246 across from one of these aftercare codes because the codes in M0246 do show up in the claim and are not in violation of the coding guidelines.

The instruction in the official ICD-9 coding guidelines regarding the coding of pathological fractures is found in the chapter-specific guidelines for Chapter 13 Musculoskeletal Disorders, and the guideline regarding the coding of traumatic fractures is found in the chapter-specific guidelines for Chapter 17 Injuries and Poisonings.