Orthopedic Coding Alert

Confirm side of foot and displacement of fracture.

ICD-9 offers only a single code for closed fracture of metatarsal bone(s) - 825.25 (Fracture of metatarsal bone[s] closed). Note that is the only code for the closed fracture of one or more metatarsal bones and is not specific for a particular metatarsal bone. You can report the same code for fracture in any metatarsal bone, first to fifth.

Adopt this 3-step Approach for ICD-10 Codes

When reporting Jones fracture in ICD-10, the following steps will help to guide you to the most accurate code:

1. Determine if the fracture is displaced or nondisplaced.
2. Determine if the fracture is in the right or the left foot.
3. Determine if the fracture is open or closed.

"Because of the significant differences in fracture coding between ICD-10 and ICD-9, it is imperative that coders begin educating their physicians well in advance of the ICD10 implementation date," 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.

"Key areas to cover are the expansion from 4 or 5 digit codes to 7 digit codes that require the physician to document location of fracture, including laterality, whether the fracture is open or closed, and whether the fracture is displaced or nondisplaced at the time of the initial encounter, says Stout. "For the follow-up encounter, the physician must indicate whether the fracture is healing in a routine manner, delayed manner, or if a malunion or nonunion has developed."

ICD-10: The future code set offers more specific options for this fracture than ICD-9 does.

• S92.351 -- Displaced fracture of fifth metatarsal bone, right foot
• S92.352 -- Displaced fracture of fifth metatarsal bone, left foot
• S92.353 -- Displaced fracture of fifth metatarsal bone, unspecified foot
• S92.354 -- Nondisplaced fracture of fifth metatarsal bone, right foot
• S92.355 -- Nondisplaced fracture of fifth metatarsal bone, left foot
• S92.356 -- Nondisplaced fracture of fifth metatarsal bone, unspecified foot.

Tip: You need to pay attention to the sixth digit to pick up the right code. "The 6th digit will refer to laterality and displacement," says Ruby O’Brochta-Woodward, BSN, CPC, CCS-P, COSC, ACS-OR, compliance and research specialist, Twin Cities Orthopedics, P.A.

The seventh character is chosen based on the encounter:

"A" indicating initial encounter for closed fracture

"B" indicating initial encounter for open fracture

"D" indicating subsequent encounter for routine healing

"G" indicating subsequent encounter for delayed healing

"K" indicating subsequent encounter for non-union

"P" indicating subsequent encounter for malunion

"S" indicating sequela (pathological fracture for a fracture caused by a disease process or a late effect)

"The 7th character extenders are used for fracture code assignment in ICD-10-CM to indicate the encounter," says Josie Dunn, CPC, Department of Orthopedics, University of Maryland Faculty Practices, Maryland. "The 7th digit will refer to episode of care: initial closed fracture, initial open fracture, subsequent, sequelae, delayed union, nonunion, and malunion," says Woodward. 

How is ICD-10 Different?

When your surgeon does not document if the fracture was open or closed, you report the fracture as closed. This is also applicable for ICD-9 currently. "ICD-10-CM guidelines state that a fracture not indicated as open or closed should be coded to closed," says Dunn. However, unlike ICD-9, ICD-10 indicates that you may report a fracture as displaced when your surgeon does not document the displacement. "ICD-10-CM guidelines also state that a fracture not indicated, whether displaced or nondisplaced, should be coded to displaced," says Dunn.

Higher stakes: "ICD-10 codes are far more specific and require greater specificity on the part of the providers to ensure correct ICD-10 code selection for the type of fracture (open vs closed, late effect or sequela), the state of the healing process (routine, delayed, malunion, or nonunion), the type of encounter (initial or subsequent), and the side (right vs left)," says Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner, Precision Auditing and Coding, senior orthopedic coder & auditor, The Coding Network, Washington.

Stress fracture: In ICD-9, you report stress fracture of 5th metatarsal with code 733.94 (Stress fracture of the metatarsals). This maps to M84.376A (Stress fracture, unspecified foot, initial encounter for fracture) and M84.379A (Stress fracture, unspecified toe[s], initial encounter for fracture) in ICD-10. "In ICD-10 stress fractures will be defined as foot and toe.  There will be no separate designation for metatarsal," says Woodward. "Nonunion/delayed union/malunion will be the same base code as the original fracture and defined by the 7th digit."