Orthopedic Coding Alert

Know the right clinical terms, and the codes will follow Healthcare providers often discuss fractures in a language peculiar to the specialty involved. Not only must the physician understand this language, but so must coders. Often, the appropriate code selection depends on knowing the precise description of the fracture pattern. Providers classify fractures according to four criteria: 1. the bone involved 2. the fracture's location 3. the pattern of the fracture fragments 4. the amount of anatomic disruption. The bone involved is obviously critical for choosing the correct ICD-9 and CPT codes. Thus, we-ll examine the definitions of the other fracture descriptors, and see how they affect coding. Pinpoint Fracture Location to Select the Right Codes The first step in identifying a code for a patient's fracture treatment is to know where the fracture occurred. The following list should help you nail down an accurate location: Diaphysis: The diaphysis is the main shaft of long, tubular bones. If your surgeon calls the fracture "a diaphyseal fracture," he is referring to a shaft fracture for coding purposes. Physis: The physis, colloquially called the "growth plate," is present only in a growing bone. It is the cartilaginous growth plate that occurs near the end of a long bone. At skeletal maturity, the physis ossifies and fuses with the epiphysis and the metaphysis. Many of these fractures are intra-articular and are discussed in more detail below. Epiphysis: The epiphysis is the end of a long bone between the physeal cartilage (physis) and the articular cartilage. Fractures through the epiphysis are virtually always considered intra-articular. Metaphysis: The metaphysis is the flared end of a long bone and is located between the diaphysis and the physis. You probably won't find any coding significance regarding this region. Fractures through the metaphysis are usually considered part of the shaft for coding purposes. Confirm Fracture Patterns You-ll have trouble pinpointing a CPT code unless the physician outlines whether the patient suffered a closed or open fracture. Here's a breakdown of how to identify fracture patterns: Closed fracture: A closed fracture is one in which the skin is intact overlying the fracture and its hematoma. Open fracture: An open fracture, formerly called a "compound fracture," is one in which there is a break in the integument at the fracture site or fracture hematoma. The size of the break in the skin is immaterial in classification as an open fracture, although it carries prognostic significance. You may see these described as Grade I, Grade II or Grade III (and there are subclassifications of those), but for coding, the only important distinction is open or closed. For coding purposes, the ICD-9 codes are similar for closed and open fractures, but differ [...]