Orthopedic Coding Alert

Can you differentiate a closed versus open fracture?

Do you know how to classify a "missile" fracture? If not, it's time for a quick reminder of these fracture types and terminology.

Knowing a fracture site isn't enough. If you look at your ICD-9 manual, you'll note that most fractures are listed first by site but then according to whether the fracture is closed or open.

Example: Suppose your surgeon diagnoses a patella fracture. In the index of the ICD-9 manual, you look up "fracture," after which you will see a listing of the sites. If you move to "knee," the subheading will say "closed 822.0," followed by "open 822.1." Therefore, if you don't know whether the surgeon diagnosed an open or closed fracture, you won't be able to assign an accurate code.

Closed fractures refer to fractures in which the skin remains intact, with no broken skin or protruding bone at the site, says Sandy Milleman, CPC, coder/biller at OSMC Outpatient Surgery Center in Elkhart, Ind.

"Every doctor I've worked with said you should consider fractures all closed unless told otherwise," says Millie Miller, CPC, certified professional coder/biller at the Bone and Joint Institute Inc. in St. Louis. "One doctor assured me, 'Don't worry; we'll let you know if it was open.'"

In an open fracture, the end of a bony fragment sticks through the skin, or there is an opening between the skin and the fracture. "The precise technical definition is that the fracture hematoma communicates with an open wound," says Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C.

Key: You can know for sure whether your physician treated an open fracture if the documentation includes the words "missile," "puncture," "open," or "with foreign body." The term "compound" is an older term for an open fracture, and most physicians don't use it anymore, Mallon says.

Editor's Note: Want a PDF listing fracture terminology, which defines words like "intra-articular" and "Galeazzi"? E-mail the editor at leighd@eliresearch.com with "Fracture PDF" in the subject line.