Orthopedic Coding Alert

Question: Our orthopedic surgeon documented fracture care for an open scapula fracture, and our coder automatically assigned the open fracture care code, but I didnt think open fractures always required open treatment. Who is right?

Alabama Subscriber

Answer: An open fracture occurs when a patient breaks his bone and the skin, and has an open wound down to the fracture site. For such a fracture to the scapula, for example, youd report 811.1x (Fracture of scapula; open).

Many coders mistakenly assume that open fractures require open treatment, in which the physician makes a surgical incision to treat the fracture.

If the orthopedist performs open fracture care at the scapula, you should report 23585 (Open treatment of scapular fracture [body, glenoid or acromion] includes internal fixation, when performed). But you should not assume that this code is accurate just because the physician documented an open fracture.

Physicians can address open fractures using closed fracture treatment as well. Closed treatment can include casting, strapping, and splinting.

If your physician tells you that he performed closed fracture care of the scapula, you should report 23570 (Closed treatment of scapular fracture; without manipulation) or 23575 (... with manipulation, with or without skeletal traction [with or without shoulder joint involvement]).

If the orthopedist does not specify whether he performed open or closed treatment, you should ask him which service he performed rather than simply assuming that he performed open treatment. Ninety-nine percent of  the time, the physician does -- but dont be caught by that 1 percent.