Outpatient Facility Coding Alert

Provider documentation will help you sort through 40-plus possible diagnoses.

When ICD-10 goes into effect in October 2014, a prime example of a diagnosis that will offer many more choices is fracture of the distal phalanx(es) of the hand, which will expand from two diagnoses to more than 40. Start educating your providers now about the two things they'll need to clearly document before you can successfully code the treatment.

Get the Lowdown on Options

ICD-9 distinguishes distal fracture codes by whether the patient has an open or closed break. You simply choose between 816.02 (Closed fracture of distal phalanx or phalanges of hand) for a closed fracture and 816.12 (Open fracture of distal phalanx or phalanges of hand) for an open fracture.

Looking ahead: Under ICD-10, you're choices will expand many times over. "There are multiple codes that apply just to distal phalanx fracture of the thumb," says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, with Coder on Call, Inc., in Milltown, N.J., and orthopedic coding division director of The Coding Network, LLC, in Beverly Hills, CA. A few examples of codes you might use include:

• S62.521A -- Displaced fracture of distal phalanx of right thumb, initial encounter for closed fracture
• S62.525A -- Nondisplaced fracture of distal phalanx of left thumb, initial encounter for closed fracture
• S62.634A -- Displaced fracture of distal phalanx of right ring finger, initial encounter for closed fracture
• S62.522B -- Displaced fracture of distal phalanx of left thumb, initial encounter for open fracture
• S62.666B -- Nondisplaced fracture of distal phalanx of right little finger, initial encounter for open fracture.

With so many code possibilities, providers will need to specify which phalanx was involved, plus document whether the fracture is displaced or nondisplaced.

Whittle List to 4 Codes for Unspecified Phalanx(es)

Even with the multitude of detailed codes in ICD-10, you'll still sometimes have to resort to "unspecified."

Example 1: The surgeon does not document whether the right or the left thumb had the closed fracture. You'll report either ICD-10 code S62.523A (Displaced fracture of distal phalanx of unspecified thumb, initial encounter for closed fracture) or S62.526A (Nondisplaced fracture of distal phalanx of unspecified thumb, initial encounter for closed fracture) depending on whether the fracture at first encounter was displaced or nondisplaced.

Example 2: The same holds true for distal fractures of the finger: select from S62.639A (Displaced fracture of distal phalanx of unspecified finger, initial encounter for closed fracture) or S62.669A (Nondisplaced fracture of distal phalanx of unspecified finger, initial encounter for closed fracture). Again, you'll narrow the code choice based on whether the fracture is displaced or nondisplaced.

Confirm Phalange to Pinpoint Best Code Choices

ICD-10 also encourages coding to the level of which finger had the fracture, not just the right or left hand.

Tip: "Surgeons should always document the digits by name -- such as long finger or ring finger -- instead of numbers," says Bill Mallon, MD, medical director of Triangle Orthopedic Associates in Durham, N.C. "You can be confused by whether the third digit is the ring or long finger. Is the surgeon including the thumb in the count or not?"