Orthopedic Coding Alert

A patient breaks a bone, the orthopedic surgeon repairs it, and the coder reports the codes on the claim. Simple, right?

Not so fast: If you don’t have a grasp on the different types of fractures, your claims could be stopped before they start. Knowledge of fracture types is essential to choosing the most accurate diagnosis for the patient and filing the most accurate claim possible with the best chance at reimbursement.

Check out this primer on different fracture types you’re likely to encounter in an ortho setting.

Break Down Differences Between Displaced, Nondisplaced

One of the most basic fracture differences is between a displaced and a nondisplaced fracture. According to Cathy Satkus, CPC, COBGC, of Harvard Family Physicians in Tulsa, Oklahoma, “displaced fracture is when the bone breaks into two or more pieces and move out of place or the bones displace, and the bones are no longer in alignment. Nondisplaced fracture is when the bone either breaks or cracks but the bones stay in alignment or stay in place.”

The difference between displaced and nondisplaced can affect care, says Nate Felt, MS, ATC, PTA, CPC, of Utah-based Intermountain Medical Group.

“Displaced and nondisplaced fractures refer to the alignment of the bone, while nondisplaced fractures the bone typically stays aligned in an acceptable position for healing. These fractures can typically be treated with a splint, brace or cast,” he says. “Displaced fractures are when the fractured ends of the bone have come out of alignment. These often need to be manipulated back into alignment.”

Important: According to notes in ICD-10, “a fracture not indicated as displaced or nondisplaced should be coded to displaced.”

Some examples of ICD-10 codes for displaced/nondisplaced fractures include:

• S62.633X (Displaced fracture of distal phalanx of left middle finger)
• S62.650X (Nondisplaced fracture of middle phalanx of right index finger)
• S72.321X (Displaced transverse fracture of shaft of right femur)
• S72.324X (Nondisplaced transverse fracture of shaft of right femur).

Comminuted/Segmental Are Similar … but not the Same

In an orthopedic setting, you might also come across notes for a comminuted/segmental fracture. “A segmental fracture is a fracture composed of at least two fracture lines that together isolate a segment of bone, usually a portion of the diaphysis of a long bone,” explains Felt.

“These fractures typically occur after a high velocity impact or injury, like a car accident, gunshot, but aging and brittle bones can also lead to comminuted fractures,” explains Satkus. Further, “a segmental fracture is a type of comminuted fracture. Comminuted fractures occur when the bone breaks into two pieces. Segmental fracture is a break of three or more pieces.

“Both types of fractures can cause intense pain, swelling, change in color of the skin, warm to the touch, bruising and there might be obvious visual evidence of the break,” Satkus continues.

Examples of segmental/comminuted fracture ICD-10 codes include:

• S72.353X (Displaced comminuted fracture of shaft of unspecified femur)
• S72.361X (Displaced segmental fracture of shaft of right femur)
• S72.364X (Nondisplaced segmental fracture of shaft of right femur).

Spine Fractures = Compression

There is another type of fracture that orthopedic coders might run into, especially if they code for spinal injuries: a compression fracture.

Compression fracture typically occurs when one or more bones in the spine weaken and crumple, says Felt. Compression fractures can be due to trauma or be caused by a loss of bone mass — osteoporosis — that occurs as a part of aging. “Something as simple as a cough or lifting a heavy object may cause a compression fracture,” explains Felt.

Satkus recommends that coders look at it this way:

• “Compression fractures occur in the spine and are caused by osteoporosis, weak or brittle bones or an injury.
• “When it is due to injury pain is typically immediate and felt in back, hips, gluteus, arms or legs. In addition to pain there could be numbness or weakness in the arms or legs.
• “When the compression fracture is due to osteoporosis or weak bones the pain might start gradually and get worse over time. Sometimes there is mild, or no pain involved.
• “Compression fractures can also cause loss of height due to the collapse of the vertebrae. There might be impairment of daily living activities, a curved back or kyphosis, digestive problems and trouble breathing.”