Orthopedic Coding Alert

Question: Which diagnosis codes should I report for a patient who fractured two metacarpal bones and three phalanges (all closed) in a fall from scaffolding while working at a construction site?

Tennessee Subscriber

Answer: You should report each fracture separately. Choose the proper phalanges codes from 816.0X (Fracture of one or more phalanges of hand; closed) and the proper metacarpal codes from 815.0X (Fracture of metacarpal bone[s]; open).

Finding the appropriate ICD-9 code for each fracture will allow you to link each to the proper CPT code for each individual procedure, such as 26615 (Open treatment of metacarpal fracture, single, includes internal fixation, when performed, each bone) or 26735 (Open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, includes internal fixation when performed, each).

Bottom line: You should list the individual fractures whenever possible. Reserve a multiple fracture code, such as 817.0 (Multiple fractures of hand bones; closed), for those rare times when you can't get specific information on the individual fractures.

Because you may be reporting this case to workers- comp, you also should consider the appropriate E codes to explain what happened. For this patient, report E881.1 (Fall from scaffolding) and E849.3 (Place of occurrence; industrial place and premises).

-- Reader Questions and You Be the Coder were reviewed by Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network LLC; and Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C.