Orthopedic Coding Alert

Question: A patient had an unspecified displaced fracture of the first cervical vertebra. When I looked this up in the ICD-10 code book, I saw that there were six 7th character options for the diagnosis. I thought there were only three 7th characters, so it gave me pause. Can you help?

AAPC Forum Participant

Answer: It’s true that some of the ICD-10 code offer more 7th character options than the typical A (… initial encounter), D (… subsequent encounter), and S (… sequela).

Do this: Go back and check the notes for your patient and see if you can answer these questions:

• Is this an initial, subsequent, or sequela encounter for the fracture?
• Was the fracture closed or open?
• Is the fracture healing routinely?
• Is the fracture healing delayed for some reason?
• Is there a nonunion in the fracture?

Then, report S12.000- (Unspecified displaced fracture of first cervical vertebra) to represent the patient’s condition, with one of these 7th characters, depending on encounter specifics.

• A (… initial encounter for closed fracture)
• B (… initial encounter for open fracture)
• D (… subsequent encounter for fracture with routine healing)
• G (… subsequent encounter for fracture with delayed healing)
• K (… subsequent encounter for fracture with nonunion)
• S (… sequela)