Radiology Coding Alert

After performing the X-rays, the radiologist diagnoses the patient as having a closed fracture of the nasal bones, as the bones did not tear through the skin.

Reporting the Fracture Depends on the 7th Character

Now it’s up to you to report the correct code. The ICD-10-CM codes regarding the fracture of nasal bones are as follows:

• S02.2XXA (Fracture of nasal bones, initial encounter for closed fracture);
• S02.2XXB (… , initial encounter for open fracture);
• S02.2XXD (…, subsequent encounter for fracture with routine healing);
• S02.2XXG (…, subsequent encounter for fracture with delayed healing);
• S02.2XXK (…, subsequent encounter for fracture with nonunion); and
• S02.2XXS (…, sequela).

In the case study above, S02.2XXA would be the correct code as the radiologist has documented a closed fracture, and this is the patient’s initial encounter for treatment.

Coding Tip: If you have documentation that doesn’t indicate if the fracture is open or closed, you should default to coding the fracture as closed. Additionally, if the documentation doesn’t indicate if the fracture is displaced or not displaced, you should code the fracture as displaced.

When coding a nasal bone fracture, the 7th character is key to documenting the diagnosis. Adding the 7th character of A, B, D, G, K, or S to the end of the ICD-10-CM code will ensure proper reporting and identify if the episode of care is initial, subsequent, or sequela.

You will find definitive distinctions between initial and subsequent care.

Initial care: According to the ICD-10-CM Chapter 19 Guidelines, “Traumatic fractures are coded using the appropriate 7th character for initial encounter (A, B, C) for each encounter where the patient is receiving active treatment for the fracture. The appropriate 7th character for initial encounter should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion.”

Subsequent care: Subsequent encounters (7th characters D, G, K) count as “encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase.” Some examples of subsequent care include brace change or removal, medication adjustment, follow-up visits following injury treatment, and other aftercare. You will use the 7th character, D, during the recovery phase, regardless of how many times the patient has been seen for the problem.

Sequela: Sequela is a term to define the late effects of an injury. In the ICD-10-CM guidelines, the 7th character, S, is “for use for complications or conditions that arise as a direct result of a condition, such as scar formation after a burn.” The character requires you to code the injury that resulted in the sequela along with the code for the sequela. It identifies the injury responsible for the sequela.

Keep These CPT^® Codes Handy for X-rays or CT Scans

A doctor will order an X-ray or CT scan to check for broken nasal bones or other broken facial bones. When a radiologist performs X-rays, they may take multiple views from different positions to help them determine a diagnosis. If the radiologist captures three distinct views of the nasal bones, you’ll code the procedure with CPT^® code 70160 (Radiologic examination, nasal bones, complete, minimum of 3 views). When a physician takes less than three distinct views of the sinus area, you’ll use 70210 (Radiologic examination, sinuses, paranasal, less than 3 views). However, if the radiologist takes at least three views of the sinus area, you’ll use code 70220 (…, complete, minimum of 3 views).

Depending on the severity of the fracture, the radiologist may recommend a computed tomography (CT) exam. This test “is the imaging modality of choice for evaluating facial trauma because of its ability to identify the exact anatomic location of fractures” (URL: www.ncbi.nlm.nih.gov/pmc/articles/PMC3820733/). If the physician orders a CT scan without contrast material to accurately diagnose the patient’s condition, then you will use 70486 (Computed tomography, maxillofacial area; without contrast material).

After the diagnosis, the doctor will discuss treatment options with the patient. These treatments can include applying cold compresses to reduce the swelling, medication such as NSAIDs or analgesics, manual alignment of the bones to help them heal in the correct position, or surgical repair later.