Radiology Coding Alert

Right or left, initial or subsequent, displaced or nondisplaced -- gather it all for new codes.

If you want a glimpse of diagnoses that will have expanded coding options under ICD-10, just take a look at codes related to fractures. As an example, here's a closer look at the codes that will replace 820.03 for a closed fracture of the base of the femur neck when ICD-10 goes into effect in 2013.

ICD-9: Under ICD-9, you may use 820.03 (Fracture of neck of femur; transcervical fracture, closed; base of neck).

ICD-10 changes: General Equivalency Mappings (GEMs) point you to the following as rough replacements for 820.03:

S72.043A, Displaced fracture of base of neck of unspecified femur, initial encounter for closed fracture

S72.046A, Nondisplaced fracture of base of neck of unspecified femur, initial encounter for closed fracture.

The two main distinctions between ICD-9 and ICD-10 are ICD-10's (1) use of "displaced" and "nondisplaced" and (2) mention of the encounter.

Displaced/nondisplaced: Be sure your providers know you need to see either "displaced" or "nondisplaced" in the documentation for fractures. If they don't, ICD-10 supplies the helpful instruction that fractures not indicated as displaced or nondisplaced should be coded as displaced.

Encounter: The sample ICD-10 codes above reference the initial encounter, but ICD-10 uses most of the alphabet to add to your seventh-digit, encounter-related coding options for this range. Below are the options for closed fractures:

A, initial encounter for closed fracture

D, subsequent encounter for closed fracture with routine healing

G, subsequent encounter for closed fracture with delayed healing

K, subsequent encounter for closed fracture with nonunion

P, subsequent encounter for closed fracture with malunion

S, sequela.

But that's not all: You may have noticed that the sample ICD-10 descriptors above state "unspecified femur." ICD-10 also offers options specific to the right femur and the left femur, so the radiologist should be sure to document which leg is injured:

S72.041-, Displaced fracture of base of neck of right femur

S72.042-, Displaced fracture of base of neck of left femur

S72.044-, Nondisplaced fracture of base of neck of right femur

S72.045-, Nondisplaced fracture of base of neck of left femur.

Remember: When ICD-10 goes into effect on Oct. 1, 2013, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at http://www.cms.gov/ICD10/ and http://www.cdc.gov/nchs/icd/icd10cm.htm#10update.