Orthopedic Coding Alert

Question:  Our physician saw and treated a patient for a scaphoid fracture. The patient, however, fell again and presented with re-fracture of the scaphoid within the previous fracture’s 90-day global period. How should we report this?

Alabama Subscriber

Answer: Because this was a new injury, you should count this as a separate encounter. For your diagnosis, you should report 814.01 (Fracture of carpal bone[s]; closed; navicular [scaphoid] of wrist). 

If your practice reports E codes to track the injury’s mechanism, use E888.9 (Unspecified  accidental fall). As for your E/M service, you should report the level based on your physician’s documentation (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient …). 

Because this visit takes place during the initial injury’s global period, add modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) to 9921X.

If your physician performs a repeat procedure (such as 25622, Closed treatment of carpal scaphoid [navicular] fracture; without manipulation), add either modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) or modifier 77 (Repeat procedure or service  by another physician or other qualified health care professional). Again, this is because this procedure takes place during the initial injury’s global period.

ICD-10: When your diagnosis system changes, you will look to the S62.0--- series of codes, which specify more detail (such as nondisplaced versus displaced, anatomical location, laterality, encounter). Make certain your physician begins documenting this. For E888.9, you have W19.xxxA (Unspecified fall, initial encounter) and W19.xxxD (… subsequent encounter). However, you should always code to the highest level of specificity. ICD-10-CM covers a vast array of falls.