Inpatient Facility Coding & Compliance Alert

Tip: Confirm underlying disease and site before you pick up the right code.

Orthopedics is one specialty that will experience tremendous change under ICD-10, especially in how you identify types of fractures. Simplify your future code choice for pathological fracture of vertebrae by knowing what to look for in the operative note.

FYI: Vertebral fractures are nearly twice as common as other osteoporotic fractures in the wrist or hip, according to the American Academy of Orthopedic Surgeons. Osteoporotic vertebral fractures occur in nearly 700, 000 patients each year.

ICD-9 code: In ICD-9, you report code 733.13 (Pathological fracture of vertebrae) for pathological fracture of vertebrae. This single ICD-9 code corresponds to several ICD-10 codes.

ICD-10 options: Going further in ICD-10, you will need to be very specific regarding the underlying cause for the fracture.

Confirm the Cause of Vertebral Fracture

For an osteoporotic vertebral fracture that occurs due to aging, you report code M80.08XA (Age-related osteoporosis with current pathological fracture, vertebra[e], initial encounter for fracture).

For any other cause of the osteoporotic fracture like steroid use, hypogonadism, or endocrinological conditions, you report ICD-10 code M80.88XA (Other osteoporosis with current pathological fracture, vertebra[e], initial encounter for fracture).

When the fracture is caused by neoplastic conditions, you will choose ICD-10 code M84.58XA (Pathological fracture in neoplastic disease, other specified site, initial encounter for fracture). When the vertebral fracture occurs due to any other disease condition, you will report ICD-10 code M84.68XA (Pathological fracture in other disease, other site, initial encounter for fracture).

Another option in ICD-10 is code M84.48XA (Pathological fracture, other site, initial encounter for fracture) which specifies that the fracture is a pathological fracture.

“You should use the most descriptive code when choosing your diagnosis,” says Gregory Przybylski, MD, director of neurosurgery for the New Jersey Neuroscience Institute, JFK Medical Center, in Edison. Since there are diagnostic codes for pathological vertebral fractures, you should not use the diagnostic codes that attribute the fracture to another site.

Look for Location of Collapsed Vertebra

When you surgeon documents collapsed vertebra, you can look for specific codes depending upon the anatomical location of the fracture. You select from codes M48.52XA (Collapsed vertebra, not elsewhere classified, cervical region, initial encounter for fracture), M48.54XA (Collapsed vertebra, not elsewhere classified, thoracic region, initial encounter for fracture), or M48.56XA (Collapsed vertebra, not elsewhere classified, lumbar region, initial encounter for fracture) for the vertebral fractures in the cervical, thoracic, and lumbar regions, respectively.

Be specific for junctions: If your surgeon documents a vertebral fracture and collapse at the junction of two regions, you again need to be specific. For the collapse at the junction of cervical region with the skull, you report code M48.51XA (Collapsed vertebra, not elsewhere classified, occipito-atlanto-axial region, initial encounter for fracture) and for that at the junction of the cervical and thoracic region, you report code M48.53XA (Collapsed vertebra, not elsewhere classified, cervicothoracic region, initial encounter for fracture). For the collapse at junction of thoracic and lumbar region, you submit code M48.55XA (Collapsed vertebra, not elsewhere classified, thoracolumbar region, initial encounter for fracture) and for that at junction of lumbar and sacral region, you submit code M48.57XA (Collapsed vertebra, not elsewhere classified, lumbosacral region, initial encounter for fracture).

An exception is code M48.58XA (Collapsed vertebra, not elsewhere classified, sacral and sacrococcygeal region, initial encounter for fracture) which you can report for collapse in both the sacral and junction of sacrum and the tail bone, also called the coccyx. However, when your surgeon does not document the location of the collapse, you report code M48.50XA (Collapsed vertebra, not elsewhere classified, site unspecified, initial encounter for fracture).