Radiology Coding Alert

Locating the correct hand or finger fracture code in the ICD-10-CM code set can feel difficult, especially when you need to account for guidelines, which bones were injured, and the extent of the injury. Plus, the CPT^® code set has its own rules for reporting X-ray exams. However, Radiology Coding Alert has gathered guidance to help your fracture coding go smoothly.

Examine the following scenarios to know how to accurately code hand and finger exams and fractures.

Hook the Correct Code for a Boxer’s Fracture

Scenario: A 32-year-old patient is referred to your outpatient radiology practice by their general physician (GP). The patient has been taking boxing classes at the local gym. The patient’s chief complaints were bruising on the front and back of the right hand, sharp pain around the fifth digit, and limited mobility of the fourth and fifth digits. The radiologist captured posteroanterior (PA) and lateral hand X-ray views, compiled their report, and issued a finding of boxer’s fracture.

In this scenario, you’ll assign 73120 (Radiologic examination, hand; 2 views) to report the two-view hand X-ray examination. The radiologist performed the examination and interpreted the results, so you can report 73120 without modifiers 26 (Professional component) or TC (Technical component …).

However, you may need to include a laterality modifier to indicate which hand the radiologist examined, depending on your individual payer preferences. “The laterality codes, RT (Right side) and LT (Left side) are often used to specify which side is imaged, and most payers require them,” says Trina Bennington, RCC, CPC, certified coding specialist and radiology coding consultant for Tennessee Interventional and Imaging Associates and Maverick Medical AI, located in Granbury, Texas.

For this scenario, you’ll append RT to 73120 if your payer requires a laterality modifier.

Diagnosis definition: A boxer’s fracture occurs when the neck of the fifth metacarpal bone fractures, and the injury is very common for inexperienced boxers. The metacarpal bones connect the phalanges (finger bones) to the carpals (wrist bones) and are found inside the flat part of the hand. The fifth digit, also known as the pinky finger, is the affected digit in a boxer’s fracture.

With this information in mind, you’ll look for a fifth metacarpal neck fracture in the ICD-10-CM Alphabetic Index to locate S62.33- (Displaced fracture of neck of other metacarpal bone), which you’ll verify in the Tabular List.

In the Tabular List, you’ll need a 6th character to specify the hand and digit affected by the injury. You’ll also need a 7th character to complete the code. You’ll assign S62.336A (Displaced fracture of neck of fifth metacarpal bone, right hand, initial encounter for closed fracture) to report the diagnosis.

Remember your training: The scenario doesn’t specify if the fracture is displaced or nondisplaced as well as if the fracture is open or closed. According to the ICD-10-CM Official Guidelines, section I.C.19.c, you’ll report a fracture as displaced if the documentation doesn’t indicate whether it is displaced or nondisplaced. Additionally, you’ll report a fracture as closed if the documentation doesn’t indicate if the injury is open or closed.

Ensure Your Phalanx Fracture Coding is Safe

Scenario: A 17-year-old patient presents to urgent care after sustaining an injury during a baseball game. The patient slid headfirst into third base and injured their hands, sustaining an injury to the third digit on their right hand and they’re also complaining of left hand pain. The radiologist, who is employed by the urgent care facility, captures PA and lateral X-ray views of the patient’s left hand and PA and lateral views of the patient’s right third digit. After reviewing the images, the radiologist reports their findings of a middle phalanx fracture of the right third digit while the left hand appears normal.

In this scenario, the radiologist captured a two-view X-ray of the patient’s left hand and a two-view X-ray of the patient’s third digit on the right hand, which means you’ll need two separate CPT^® codes for the encounter. You’ll assign 73120 for the left hand X-rays and then you’ll assign 73140 for the right finger X-rays.

Unbundling guidance: Normally, you wouldn’t report 73120 and 73140 together since 73120 is a more extensive procedure that inherently includes the finger X-rays covered by 73140. However, since the imaging exams occurred on separate hands, you may override the bundle.

“There is a National Correct Coding Initiative (NCCI) edit for codes 73120 and 73140 where a modifier can be used to override the edit. The modifier is applied on the finger code 73140 as this is in Column 2 and is included in 73120,” Bennington says.

Which modifier? You’ll append 73140 with either modifier 59 (Distinct procedural service) or one of the X{EPSU} modifiers, like XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure), depending on your payer preferences. Adding the correct unbundling modifier indicates that the X-rays were captured on separate structures during the encounter.

Next, you’ll assign S62.622A (Displaced fracture of middle phalanx of right middle finger, initial encounter for closed fracture) and M79.642 (Pain in left hand) to report the radiologist’s findings. While the provider found the patient did fracture a finger on their right hand, the radiologist didn’t find any abnormalities with the left hand. In that case, you’ll report the patient’s symptoms, which is left hand pain.

Overcome Documentation Challenges

You may encounter challenges when coding hand and finger X-rays. One hurdle pertains to whether you can code hand and finger fractures on a single report.

“If the fractures are both mentioned on one report in the title, but the technique and report body findings do not clearly show both with findings, I either send back for addendum/clarification or code only the hand based on client preferences/guidelines,” Bennington says.

Another obstacle that you may face is knowing what tests were ordered. When you know what test was ordered versus what was performed, you can accurately code the encounter. “Is it just the hand to include the fingers, or is it just the fingers? You could have an order for the left hand for finger injury and would only code the hand, you could have an order for the fingers, or the order could include both,” Bennington adds.