Primary Care Coding Alert

Know these keywords to select the right ICD-9 code every time

When you review your fracture diagnosis coding options, you might get confused about whether the fracture is open or closed. In most cases, the family physician will only see closed fractures, because open fractures involve a puncture to the skin and often require surgery.

You can know for sure whether your physician treated an open fracture if the documentation includes the words -compound,- -infected,- -missile,- -puncture,- -open,- or -with foreign body.-

Case -closed-: Closed fractures refer to fractures in which the skin remains intact, with no broken skin or protruding bone at the site. Look for terms like -comminuted,- -transverse,- -depressed,- -elevated,- -fissured,- -greenstick,- -impacted,- -linear,-  -march- and -simple.- In addition, most stress fractures are closed fractures.

Tip: Unless the term -open- or -compound- appears in the diagnostic statement, you should most likely report a closed fracture code, according to the American Hospital Association's Coding Clinic.

Other terms for closed fractures are common names such as -Bennett- (an intra-articular fracture at the base of the first metatacarpal), -Colles- (an extension fracture of the distal radius, or wrist), -Smith- (flexion fracture of the distal radius, or wrist), -Tib-fib- (fracture of the tibia and fibula), -Potts- (fracture to the distal fibula), calcaneus (heel bone fracture), clavicle (collarbone), and Holstein-Lewis (spiral fracture to the humeral shaft).

To help you visualize the differences between closed and open fractures, we-ve created these drawings of two of the most common fractures that family physicians treat -quot; a Colles fracture with an ulnar fracture, and a tib-fib fracture.