Orthopedic Coding Alert
Distinguish Pathological and Traumatic Fractures
Question: A patient with metastatic carcinoma developed an anterior cord injury along with a pathologic vertebrae fracture. Are we correct to report this with ICD-9 codes 733.13 (Pathological fracture of vertebrae) along with 198.5 (Secondary malignant neoplasm of bone and bone marrow)? Is it correct to use 806.00 (Closed fracture of c1-c4 level with unspecified spinal cord injury), 806.02 (Closed fracture of C1-C4 level with anterior cord syndrome) or 806.05 (Closed fracture of C5-C7 level with unspecified spinal cord injury)?
Texas Subscriber
Answer: Since the patient has a metastatic carcinoma, it is possible that the fracture be pathological in nature. You are correct to report this condition with codes 733.13 and 198.5. Codes 806.00, 806.02, and 806.05 are not appropriate as these codes are for traumatic and not pathological fractures. However, you should seek clarification from the surgeon regarding the nature or the fracture (pathologic vs. traumatic) before assigning a code. You should also assign an additional code identifying the primary tumor, if known.
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