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Orthopedic Coding Alert

Fracture Primer:

Break Fracture Care Down to Brush Up on Basics

Published on Fri Jul 05, 2024

Do you know what a greenstick fracture is?

Fractured bones are an orthopedic practice’s bread and butter. Knowledge of terms and anatomy of fractures is a given for any successful orthopedic coder.

But what happens when you have gaps in your basic fracture knowledge? Simple mistakes can sometimes turn into expensive ones, if you face a denial because you forgot one of the tenets of fracture care.

Don’t worry: During her HEALTHCON 2024 presentation “Current Orthopedic Coding Issues,” Karen F. Perry, CPC, CPB, CPC-I, OCS, ran through the basics on fracture care that every coder should know. Check out what she had to say.

Check Out These Top Coding Errors

Perry, who has nearly 20 years’ experience as a medical coder, ran down the top five reasons for coding errors in orthopedic practices; all of them can be applied to fracture care. The errors that cause denials are:

  • Incorrect codes: “Application of incorrect codes, such as fracture codes, can cause loss of revenue,” she explained.
  • CPT® guidelines: Coders need to be aware of coding guidelines for fracture care and pay careful attention to the provider’s documentation.
  • Proper anatomical coding: It’s important to “pay attention to laterality; also when services are performed on multiple anatomical areas, there is the possibility of multiple codes,” Perry said.
  • Fixation miscoding: Some coders are using internal/external fixation codes improperly, according to Perry. Remember, only report internal/external fixation when it is not listed as part of the basic fracture care procedure.
  • Payer knowledge: You need to know “not just Medicare guidelines and regulations, but also those of private payers,” in order to code fractures correctly, explained Perry.

Know Open/Closed Definitions

A fracture is a partial or complete break in the bone. It is classified as either open or closed. An open fracture, also known as a compound fracture, occurs when the bone pokes through the skin and can be seen, or when a deep wound exposes the bone through the skin. A closed fracture, also known as a simple fracture, occurs when the bone is broken but the skin is intact.

Open vs. closed Tx: Coders also don’t want to confuse open and closed fractures, as described above, and open and closed fracture treatment. Open fracture treatment occurs when the surgeon makes an excision to expose the fracture for repair; Per CPT®, open treatment is also when the fracture is treated using an intramuscular (IM) implant placed via incision that is remote from the fracture site (with or without direct visualization of the fracture). Closed treatment occurs when the surgeon fixes the fracture without making any incisions.

Keep Up With Fracture Types

“Fractures have a variety of names,” explained Perry, and orthopedic coders will need to know all of them to code correctly. Some of the most common are:

  • Greenstick: This is an incomplete fracture where “a portion of the bone is broken, causing the other side to bend.”
  • Transverse: This is a fracture in a straight line across the bone.
  • Spiral: This is a fracture that spirals around the bone; it is common with a twisting injury.
  • Oblique: This is a fracture that is diagonal across the bone.
  • Compression: This is a fracture where “the bone is crushed, causing the broken bone to be wider or flatter in appearance,” explained Perry.
  • Comminuted: This is a fracture where the “bone is broken into three or more pieces and fragments are present at the fracture site,” said Perry.
  • Segmental: This is a fracture where the same bone is fractured in two places, resulting in a “floating” piece of bone.

Learn Different Fracture Treatments

When a patient has a fracture, surgery isn’t a given. There are other treatments that could fix the fracture; the orthopedist could use one, or a combination, of these methods to treat the patient:

  • Splinting/casting: This will immobilize the injured area and keep the bone aligned.
  • Medicine: The surgeon might prescribe medication in order to help pain control.
  • Traction: This is the use of pulley/strings to “stretch certain parts of the body in certain directions,” said Perry. “This strengthens the muscles and tendons around the broken bone to help with healing.”
  • Surgery: The orthopedist will need surgery to put certain types of breaks back into place.
  • Best bet: Be on the lookout for all of these fracture treatment types, and code them accordingly.

Recognize Most Common Fracture Presentations

There are fractures that are going to occur more often than others; sometimes it’s due to bone strength, sometimes it’s tied to patient activity levels, and sometimes patients are engaged in activities that commonly cause fractures (athletics, manual labor, etc.).

Some of the more common fractures you might see in your practice include: clavicle, wrist, hip, spine, humerus, rib, and ankle. Make sure you are up to speed on anatomy and coding for these fractures, because you’re wont to see a lot of them.

Fracture Modifiers

You’ll also want to keep up with the modifiers that are most likely to accompany your fracture care claim. Perry listed the following as the most common modifiers used on fracture care codes:

  • Modifier 22 (Increased procedural services)
  • Modifier 51 (Multiple procedures)
  • Modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period)
  • Modifier 59 (Distinct procedural service)
  • Modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period)
  • Modifiers RT (Right side) and LT (Left side).

Chris Boucher, MS, CPC, Senior Development Editor, AAPC

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