Neurosurgery Coding Alert

Confirm type of fracture and displacement.

ICD-10 raises the stakes for your dens fracture coding from a single code in ICD-9 to numerous possible codes, which will require you to specify fracture type and displacements, if any.

ICD-9: You report code 805.02 (Closed fracture of second cervical vertebra) for a dens fracture, which is among a range of codes (805.xx) for the fractures of the vertebral column. A fourth digit of "0" is used for closed fractures. The final digit "2" is specific to the second cervical vertebra (axis). "If there is a closed, displaced C2 fracture, irrespective of the type of fracture, this would additionally be reported with code 839.02 (Closed dislocation second cervical vertebra)," says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.

ICD-10: You have numerous options for reporting the fracture of dens in ICD-10.

There may be times when your surgeon does not specify the type of the fracture in which case, you confirm if the fracture was displaced or nondisplaced and appropriately report code S12.100A (Unspecified displaced fracture of second cervical vertebra, initial encounter for closed fracture) or S12.101A (Unspecified nondisplaced fracture of second cervical vertebra, initial encounter for closed fracture) .

Look for Displacement in Type II Fracture

When reporting type II dens fractures, you will need your surgeon to specifically record the direction of displacement of the dens. Depending upon the anterior or posterior displacement, you select from code S12.110A (Anterior displaced Type II dens fracture, initial encounter for closed fracture) or S12.111A (Posterior displaced Type II dens fracture, initial encounter for closed fracture). For a nondisplaced type II fracture dens, you report code S12.112A (Nondisplaced Type II dens fracture, initial encounter for closed fracture). "Clinically, the direction of displacement has both treatment implications as well as prognostic influence on healing rates," says Przybylski.

You may turn to code S12.120A (Other displaced dens fracture, initial encounter for closed fracture) or S12.121A (Other nondisplaced dens fracture, initial encounter for closed fracture) for other dens fractures, depending upon the displaced or nondisplaced description in the clinical note documented by your surgeon.

Look At Other Codes Not Mentioning 'Dens'

There are other ICD-10 codes that map to 805.02 in ICD-9. You may report these depending upon whether your surgeon documents a spondylolisthesis of the second cervical vertebra. You may select one of the codes mentioned in table 1. "While not the typical location for applying the term, spondylolisthesis refers to the displacement of the second cervical vertebra with respect to the third vertebra," says Przybylski.