Orthopedic Coding Alert

Keep these 5 items in mind.

Per ICD-9-CM, diagnosis codes for fractures are assigned by the open versus closed definition, which is the physical state of the fracture when first presented for repair.

A fracture not indicated as closed or open should be classified as closed.

Open or Closed?

Dont recognize a term as open or closed? Check out these key words:

Open (with or without delayed healing): Compound, infected, missile, puncture, with foreign body.

Closed (with or without delayed healing): Comminuted, depressed, elevated, fissured, fracture NOS, greenstick,impacted, linear, simple, slipped epiphysis, spiral.

Catch: The terms condyle, coronoid process, ramus, and symphysis indicate the portion of the bone fractured, not the name of the bone involved.

Code acute hip fractures in the 800-829 series while the patient is receiving active treatment such as an emergency room encounter, initial physician treatment, or surgical repair. Watch for multiple injuries and combination categories.

Use aftercare codes (subcategories V54.0x, V54.1x, V54.8x,or V54.9) for encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase. Examples of fracture aftercare are cast change, removal of external or internal fixation device, medication adjustment, and follow-up visits for fracture treatment out of the global surgery period.

Determine Pathological or Spontaneous

Guidelines from the National Center for Health Statistics (NCHS) went into effect Nov. 15, 2006 regarding the reporting of pathological fractures (733.1x). Report pathological fractures using subcategory 733.1x when the fracture is newly diagnosed and while the patient is receiving active treatment.

Code stress fractures in the 733.93-733.95 series.

After the patient has completed active treatment of a pathological or spontaneous fracture and is receiving routine care for the fracture during the healing or recovery phase, code aftercare in the V54.2x category.

Code for Complications

Code care for complications of surgical treatment for fracture repairs during the healing or recovery phase with the appropriate complication codes. For instance, report caring for fracture complications such as malunion and nonunion with the appropriate codes --33.81 or 733.82, respectively.

Code for Late Effect of Injuries

A late effect is the condition resulting from an injury or illness that presents after the acute phase of the injury or illness has terminated. There is no time limit on when a late effect code can be used. Coding of late effects usually requires two codes and would be sequenced with the condition or nature of the late effect sequenced first and the late effect code sequenced second. The code for the acute phase of an illness or injury that led to the late effect is never used with a code for the late effect.

Example: Code arthritis as a result of an earlier open intertrochanteric fracture (originally coded as 820.31, Intertrochanteric section) as follows:

" 716.15 (Traumatic arthropathy; pelvic region and thigh) -- mary diagnosis; and

" 905.3 (Late effect of fracture of neck of femur) -secondary diagnosis.

Dont Forget E Codes and Occurrence Codes

These codes can prevent the delay of claims when more information is needed by the insurance companies to determine who the primary payer should be as injuries can be the result of a work-related accident, auto accident, or the responsibility of a homeowners insurance policy. Here is some important information about Occurrence E codes:

The Supplemental Classification of External Causes of Injury and Poisoning (E codes, E800-E999) are supplemental codes to the application of ICD-9-CM diagnosis codes.

These codes are never to be used as primary codes.

Read the guidelines in the front of the ICD-9-CM book for correct usage.

Occurrence/Condition codes are reported on the UB-92 form and provide valuable information that will also move your claim along. Check with your local fiscal intermediary for rules and regulations that may override federal ones.

The official rule can be found at: http://www.cms.hhs.gov/Manuals/IOM/list.asp. For more information from the National Center for Health Statistics (NCHS) on ICD-9-CM coding go to: www.cdc.gov/nchs/icd9.htm. A feature located on the Web page allows you to sign up for news updates.