Podiatry Coding & Billing Alert

Hint: Go for default codes for displaced or closed fracture in absence of notes.

If you feel that you have not prepared enough for the ICD-10 implementation that has just kicked in and are intimidated with coding fracture codes, you’re not alone. Go through these two real case scenarios to capture these complicated seven character codes correctly by breaking them down into pathologic and traumatic fractures.

Perfect Your Pathologic Fractures With Scenario 1

Scenario 1: Our podiatrist saw a 72-year-old man for a fracture of the right foot. He was originally diagnosed with left upper lobe carcinoma 5 years ago, and then several months ago, he was diagnosed with metastatic bone cancer (from the lung). This foot fracture is a result of the metastatic cancer. The patient’s lung cancer has already been treated with radiation, and the patient no longer has any evidence of an existing primary malignancy. What ICD-10 code(s) should I report?

Definition: First, you need to define this type of fracture. A fracture is either traumatic or pathologic. A pathologic fracture occurs when a bone breaks in an area that is weakened by another disease process. Causes of weakened bone include tumors, infection, and certain inherited bone disorders. There are dozens of diseases and conditions that can lead to a pathologic fracture or dislocations. A pathologic fracture usually occurs with normal activities — patients may be doing very routine activities when their bone suddenly fractures or dislocates. The reason for a fracture is that the underlying disease process weakens the bone to the point where the bone is unable to perform its normal function.

Important: ICD-10-CM has three pathologic fracture categories:

• Due to neoplastic disease
• Due to osteoporosis
• Due to other specified disease

Solution: In this scenario, the pathologic fracture to the right foot was due to neoplastic disease. Therefore, the solution is:

• M84.574A — Pathological fracture in neoplastic disease, right foot, initial encounter for fracture  
• C79.51— Secondary malignant neoplasm of bone
• Z85.118 — Personal history of other malignant neoplasm of bronchus and lung
• Z92.3 — Personal history of irradiation.

Now, check out traumatic fractures.

Highlight These Traumatic Fracture Details for Scenario 2

Traumatic fractures include much greater specificity in ICD-10-CM. For example, some of the information that may be found in fracture codes include:

• the type of fracture,
• specific anatomical site,
• whether the fracture is displaced,
• laterality,
• routine versus delayed healing,
• nonunions and malunions,
• identification of type of encounter.

Red Flag: In ICD-10-CM, a fracture not indicated as displaced or nondisplaced should be coded to displaced. A fracture not designated as open or closed should be coded to closed.

Scenario 2: Your physician sees a patient for increased pain in her ankle. She has had a previous trimalleolar fracture of the left ankle. After evaluation, he diagnoses a nonunion of her left trimalleolar fracture. What should you do?

In this scenario, we know that we’re looking at the lower leg, specifically the ankle. The best root code we have is S82.8---. Expanding the code further to fifth digit, you will find “trimalleolar fracture” (character 5). Expanding the tree, you can arrive the “displaced/left” digit (character 2). Finally, you would apply K (Subsequent encounter for closed fracture with nonunion).

Solution: You should report S82.852K (Displaced trimalleolar fracture of left lower leg, subsequent encounter for closed fracture with nonunion).

Heads up: As there are no notes as to the displacement or closeness of the fracture here, therefore, as we discussed earlier, we will consider the fracture as displaced and closed and code accordingly.

Do you think you need an aftercare code? No. Aftercare Z codes should not be used for aftercare of fractures. For aftercare of a fracture, assign the acute fracture code with the correct seventh character indicating the type of aftercare.