Neurosurgery Coding Alert
New Codes and Revisions Will Transform Your Occipital Condyle Fractures Coding
Laterality is important for fractures type I, II, and III; healing status; sequela.
Effective Oct. 1, reporting for fractures of the occipital condyle has become specific for the right or left side location for the fracture. The new codes and revisions apply to initial encounter for both closed and open fractures on the occipital condyle. You will also find new codes and revisions for subsequent encounter codes for routine and delayed healing and non-union and for sequelae to the right and left sided fracture.
Fractures of occipital condyle: Occipital condyle fractures occur in brain injuries caused by high-energy blunt trauma. The mechanisms of injury may include axial compression or rotation, direct blow, and lateral bending.
Classification: Based upon the morphology and mechanism of injury, occipital condyle fractures are classified as Type I, II, and III fractures. The most common type of fracture is type II fracture (~50%) followed by type III (~35%) and type I (~15%). Of these type I and II are stable fractures and type III is unstable. Table 1 describes the three types of fractures along with the mechanism of trauma leading to the fracture.
Treatment planning may improve: “These fractures are more commonly recognized now compared to decades ago because of high quality CT imaging,” says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison. “The classification system has been used for a long time, but much remains to be determined regarding the stability of these fractures. Many may not have been treated at all in the past because these were not diagnosed. External immobilization is frequently employed in the management of these injuries. Associated injuries such as occipito-cervical dislocation and C1/C2 fractures may ultimately direct the best treatment option.”
More about occipital condyle fractures: You can read more about occipital condyle fractures in research papers available at: https://www.ncbi.nlm.nih.gov/pubmed/24744561; https://www.ncbi.nlm.nih.gov/pubmed/19189141; https://www.ncbi.nlm.nih.gov/pubmed/26562241;
New Codes Will Allow Laterality Based Reporting
As October 1, you should have added a total of 48 new codes to your coding cache. The number may sound enormous, but this is a welcome change as it allows you to specifically report the right and left sided fractures in the occipital condyle.
Table 2 lists the new codes for right and left sided type I fractures of the occipital condyle. You have new codes for initial and subsequent encounter and for sequelae. “The increased specificity of the diagnostic coding may assisted clinical researchers in providing more specific treatment recommendations, based on the specific type of fracture encountered,” Przybylski says.
Follow the same rules for other types of occipital condyle fractures: Like in type I occipital condyle fractures, you will have new codes for type II and type III fractures and other fractures of the occipital condyle.
Specify When You Do Not Know the Side
When not sure of the side for closed or open occipital condyle fractures, you can submit the diagnosis codes for ‘unspecified side.’ Revisions in the following initial encounter codes will help you achieve this. “Although the option exists, to report the fracture without specifying laterality, these should be rarely used since our diagnostic tools, specifically CT with reconstructions, should typically provide all the information needed to determine the type and side of the fracture,” Przybylski says.
Similar changes apply to open and closed fractures type II and type III:
When your physician is following up with the patient for healing, you will need to specify the side of the fracture.
If you have no document to support the laterality of the fracture, you submit code for unspecified side. Note revisions in code descriptors for routine and delayed healing and non-union in occipital condyle fractures type I.
These changes also apply to subsequent encounter to follow up on healing and non-union in type II and III occipital condyle fractures.
Also, apply laterality to sequelae of occipital condyle fractures type I, II, and III. Note the revisions in descriptors for sequelae codes below:
Other fractures: When your physician does not document right or left side for fracture of the occipital condyle other than types I, II, and III, you can choose form the following codes:
Mark the revision: As in codes for type I, II, and III, the code descriptors for ‘other fractures’ includes ‘unspecified side’ for initial and subsequent encounters, and sequelae.
You can find more about the ICD-10 changes at: https://www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-CM-and-GEMs.html.
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