Radiology Coding Alert

Use these tips to help distinguish between open and closed fractures

Quick quiz: Do you know whether a greenstick fracture describes an open fracture or a closed fracture? Or can it apply to both?

You need to be as specific as possible with your fracture diagnosis codes, says Elisabeth P. Fulton, CPC, coding and auditing department supervisor in Winston-Salem, N.C. 

First step: You must understand the difference between open and closed treatment in order to select the proper codes, says Sharon Hathaway, CPC, coder at Danbury Hospital in Danbury, Conn.

Open: When documentation includes the words "compound," "infected," "missile," "puncture," "open," or "with foreign body," choose an open fracture diagnosis code.

Closed: Closed refers to fractures in which the skin remains intact, with no broken skin or protruding bone at the site. According to the ICD-9 manual, terms such as  "comminuted," "depressed," "elevated," "fissured," "greenstick," "impacted," "linear,"  "spiral," and "simple" may indicate a closed fracture, with or without delayed healing, unless the fracture is specified as open or compound. In addition, most stress fractures you will see will be 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. Tell your physician to be specific in his documentation.

Other terms that may indicate closed fractures (unless specified as open) include "Bennett" (an intra-articular fracture at the base of the first metacarpal), "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 common fractures--a fracture of the radius and ulna, and a tib-fib fracture.