Orthopedic Coding Alert

Select code after confirming if fracture is displaced or nondisplaced.

When reporting the closed fracture of distal phalanx(es) in the hand, you invariably turned to code 816.02 (Closed fracture of distal phalanx or phalanges of hand) in ICD-9. There is, however, a wider choice for you in ICD-10.

"In ICD-9, there are only two codes that describe a distal phalanx fracture of the finger or thumb -- 816.02 for a closed fracture, and 816.12 (Open fracture of distal phalanx or phalanges of hand) for an open fracture. In ICD-10, there are 42 codes that apply just to distal phalanx fracture of the thumb," says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, Coder on Call, Inc., Milltown, New Jersey and orthopedic coding division director, The Coding Network, LLC, Beverly Hills, CA.

The bottom line: ICD-10 requires you to be specific about which phalanx(es) in particular was involved. Also, you will need your surgeon to clearly document whether the fracture is displaced or nondisplaced.

When Phalanx(es) Is Not Specified

When your surgeon does not clearly document if the right or the left thumb had the closed fracture, you report ICD-10 code S62.523A (Displaced fracture of distal phalanx of unspecified thumb, initial encounter for closed fracture) or S62.526A (Nondisplaced fracture of distal phalanx of unspecified thumb, initial encounter for closed fracture) depending upon whether the fracture at first encounter was displaced or nondisplaced.

Similarly, you will select from S62.639A (Displaced fracture of distal phalanx of unspecified finger, initial encounter for closed fracture) or S62.669A (Nondisplaced fracture of distal phalanx of unspecified finger, initial encounter for closed fracture) for displaced or nondisplaced fracture(s) of the unspecified fingers.

Confirm Phalange For Specific Codes

Check that your surgeon precisely documents which finger had the fracture of the distal phalanx. Also, make sure the clinical note captures if the closed fracture in the distal phalanx was displaced or nondisplaced. "As always, the surgeons should document the digits by name -- long finger or ring finger -- and not numbers, as that can be confusing. You may be confused if the 3rd digit is the ring or long finger, i.e., are you including the thumb in the count or not?" says Bill Mallon, MD, medical director, Triangle Orthopedic Associates, Durham, N.C.

Note: For a crosswalk of ICD-10 codes corresponding to ICD-9 code 816.02, please email the editor at tjandoo@codinginstitute.com.