Orthopedic Coding Alert

An orthopedic injury can seriously impact a child's physical maturity. Coding for these injuries is often challenging, considering the variety of playground accidents and sports injuries to which active youths are prone.
Fractures
Joanne Simmons, CPC, surgery coordinator at Nemours Children's Clinic in Orlando, Fla., reports that the most common sports-related injuries among pediatric patients are fractures of the humerus and femur. "Kids seem to fracture their humerus fairly frequently by falling off playground equipment or bicycles," says Simmons. The two most common fractures among children, she notes, are supracondylar fractures of the humerus (812.41) and fractures of the femoral shaft (821.xx).
 
Elbow fractures are common among youths who participate in playground or intramural sports. Damage to major vessels and nerves can occur, and some patients will require surgery to correct the problem. Dislocation of the elbow is another common injury, often seen in conjunction with fractures of the medial epicondyle of the humerus (812.43, Fracture of humerus; lower end, closed; medial condyle), fractures of the neck of the radius (813.06, Fracture of radius and ulna; upper end, closed; neck of radius, or 813.16, upper end, open; neck of radius) or injury to the median or ulnar nerve (955.1, Injury to peripheral nerve[s] of shoulder girdle and upper limb; median nerve, or 955.2, ulnar nerve). Any dislocation should be treated promptly, rehabilitation should be introduced gradually and the patient should not return to the sporting activity until he or she has regained a full range of movement.
Epiphyseal Injury
Procedural coding for sports-related injuries and for those such as Simmons describes is relatively straightforward; however, coders should be certain, if the orthopedic surgeon does not do his or her own coding, that the physician's description of the injury is accurate. "It really helps when your physicians do their own coding," says Simmons. But when this is not the case, their notes must clearly describe the injuries.
 
For example, if a 6-year-old patient presents with a femoral fracture, the likelihood is great that the fracture may have occurred at the epiphyseal growth plate (the part of the still-growing bone that controls its eventual length). An epiphyseal injury can have long-term impact on the patient's development; thus, codes for its repair are different from those of a "normal" fracture. Repair codes in these cases include 27516 (Closed treatment of distal femoral epiphyseal separation; without manipulation), 27517 ( with manipulation, with or without skin or skeletal traction) and 27519 (Open treatment of distal femoral epiphyseal separation, with or without internal or external fixation).
Overuse Injury
Children who participate in gymnastics, hockey, diving and wrestling can develop injuries from overuse. The patient may report with tenderness in the triceps (729.5, Pain in limb). The [...]