Orthopedic Coding Alert

Don’t overlook your “bilateral” option for a multiple rib fracture situation.

Fracture codes both explode and transform in ICD-10, which means you need to embrace any tool that can streamline your code selection.

Take a look at the following chart for rib fractures, and check out how you can easily “build” your seven digit diagnosis, based on your physician’s documentation.

Follow These First Column Instructions

You should determine whether the fracture occurred in one rib or multiple ribs. If the injury was to one rib, you’ll begin your code with “S22.3.” If the rib was to multiple ribs, you’ll use “S22.4” instead.

Tip: Once you have this code chosen, you’ll follow the same row over to the next column.

Second Column Means Examining Location

In the second column, you’ll choose your fifth and sixth characters based on anatomic location.

For instance, if the patient fractured a single rib on the right, you’ll add “1X” onto your “S22.3” to make “S22.31X.” You still have to add a seventh digit.

Heads up: Because these diagnoses describe rib fractures, you only have the option of displaced. Remember, displaced fractures mean the two ends of the bone are separated from one another. Not much can be done for a fractured rib which hasn’t moved out of normal position or alignment.

Third Column Means Choosing Encounter

Finally, you need to add your last character, which means moving over to the last column. No matter what row in which you started, you will use the communal third row option, based on the patient’s encounter. The initial visit depends on whether the rib fracture was open or closed.

So, if the patient with the single fracture to his right rib (“S22.31X”) presents to your practice for a subsequent visit for routine healing, you will add “D” to complete your seven digit code. Therefore, the entire correct code will be S22.31XD.

Try Your Hand With This Example

Suppose a patient with bilateral displaced rib fractures presents for an initial visit for a closed fracture. What diagnosis code should you report?

Solution: S22.43XA.

Here’s how you arrive at this diagnosis using the chart above. In the first column, you would choose the code for multiple ribs (“S22.4”). In the second column, you would choose the option for bilateral displaced, which is “3X.” Finally, because this was the initial visit for a closed fracture, you would apply the “A” character from the third column.