Radiology Coding Alert

Hint: Stress fractures are caused by repetitive forces.

When a patient experiences a foot fracture, coding the diagnosis can be difficult due to the specific ICD-10-CM code options available. By meticulously reading the provider’s medical documentation, you’ll find the information you need to assign the correct fracture code for the encounter.

Refresh your coding knowledge on how to assign pathological, traumatic, and stress fracture codes for feet.

Type 1: Understand What Causes Pathological Fractures

Pathological fractures are caused by disease, such as osteoporosis or neoplastic disease. The disease process weakens the bone, it is not able to perform as normal, and it breaks. Oftentimes a patient will get a pathological fracture while participating in everyday activities.

Coding tip: Always read the documentation to find the underlying cause of the disease.

ICD-10-CM codes for pathological fractures: ICD-10-CM has three pathologic fracture categories — due to neoplastic disease, due to osteoporosis, and due to other specified disease. A provider may image and report the following types of pathological fractures in your radiology practice (Note: This is not an exhaustive list):

• M80.071- (Age-related osteoporosis with current pathological fracture, right ankle and foot)
• M80.072- (Age-related osteoporosis with current pathological fracture, left ankle and foot)
• M80.871- (Other osteoporosis with current pathological fracture, right ankle and foot)
• M84.471- (Pathological fracture, right ankle)
• M84.571- (Pathological fracture in neoplastic disease, right ankle)
• M84.671- (Pathological fracture in other disease, right ankle)

Example: The patient, who has neoplastic disease, suffers from a current pathological fracture of their right ankle. This is an initial encounter. The radiologist captures anteroposterior (AP), mortise, and lateral views of the patient’s ankle and interprets the results. The patient’s physician documents that the underlying neoplasm is a malignant neoplasm of the short bones of the right lower limb.

Solution: You should report M84.571A (Pathological fracture in neoplastic disease, right ankle, initial encounter for fracture) for the pathological fracture and C40.31 (Malignant neoplasm of short bones of right lower limb) for the neoplasm, plus CPT^® code 73610 (Radiologic examination, ankle; complete, minimum of 3 views) for the ankle X-rays.

7th character reminder: Don’t forget to pay attention to the icons listed in the ICD-10-CM code set. Several fracture codes, such as the ones listed above, require a 7th character to complete the code. The 7th character indicates the type of encounter or if the patient is experiencing sequela with the injury.

Fracture coding tip: Coders who also report fracture care should know that “even though nonoperative, nonmanipulative fracture care services are not surgical, they carry a 90-day global period,” says Jeri L Jordan, CPC, billing manager at Hampton Roads Foot and Ankle in Williamsburg, Virginia. “If you are billing an office visit on the same day, you would need to [report] modifier 57 [Decision for surgery] on your claim. Follow-up visits must also adhere to the global period rules.”

Type 2: Observe Codes for Traumatic Fractures

On the other hand, traumatic fractures are caused by trauma such as an accident, fall, or other kind of force, such as when a heavy object strikes a patient. When coding traumatic fractures of the foot, you should look to the following codes:

• S82.- (Fracture of lower leg, including ankle)
• S92.0- (Fracture of calcaneus). Note: This includes the heel bone and os calcis.
• S92.1- (Fracture of talus). Note: This includes the astragalus.
• S92.3- (Fracture of metatarsal bone(s))
• S92.4- (Fracture of great toe)
• S92.5- (Fracture of lesser toe(s))
• S92.8- (Other fracture of foot, except ankle)

Documentation details: When it comes to traumatic fractures, you must check for important details in the documentation including whether the fracture is closed or open.

Closed fractures involve a bone break that has not penetrated the skin. If there is no evidence of a breach of the skin in the encounter notes, you likely have a closed fracture claim on your hands. On the other hand, open fractures occur when the bone has punctured the skin or there is a significant break in the skin directly over the fracture site — not an abrasion or superficial laceration.

Coding tip: If the medical documentation does not specify whether the traumatic fracture is open or closed, you should report it as closed, according to the ICD-10-CM Official Guidelines, Section I.C.19.c, “Coding of Traumatic Fractures.”

To choose the appropriate code for the traumatic fracture, you must also know if it is displaced or nondisplaced. In a displaced fracture, the bone snaps in two or more places and moves so that the two ends are not in their normal alignment. In a nondisplaced fracture, the bone cracks either part or all the way through, but it maintains its proper alignment and has not moved from its normal position.

Coding tip: If the documentation does not indicate if this traumatic fracture is displaced or nondisplaced, code it as displaced, per the guidelines.

Example: A patient was rushed to a nearby emergency department (ED) after sustaining a leg injury in a car accident. The attending physician ordered X-rays of the patient’s leg. Following AP and lateral X-ray views of the patient’s tibia as well as the same views of the patient’s ankle, the patient was diagnosed with a closed, nondisplaced fracture of the medial malleolus of their left tibia.

Solution: Report S82.55XA (Nondisplaced fracture of medial malleolus of left tibia, initial encounter for closed fracture) on your claim. A medial malleolus fracture is a fracture of the inner side of the ankle at the end of the tibia. You’ll also assign 73590 (Radiologic examination; tibia and fibula, 2 views) and 73600 (Radiologic examination, ankle; 2 views) to report the X-rays.

Type 3: Focus on Options for Stress Fractures

Unlike pathological and traumatic fractures, stress fractures are tiny cracks in the bone caused by repetitive stress or force, often from overuse. Stress fractures often occur in normal or metabolically weakened bones. Patients may have a stress fracture without even realizing it. When a patient has a stress fracture, they usually complain of pain that is nagging or gradually building.

Coding tip: The ICD-10-CM code set tells you to report an additional external cause code to identify the cause of the stress fracture.

You should look to the following codes to report stress fractures of the foot:

• M84.371- (Stress fracture, right ankle)
• M84.372- (Stress fracture, left ankle)
• M84.374- (Stress fracture, right foot)
• M84.375- (Stress fracture, left foot)
• M84.377- (Stress fracture, right toe(s))
• M84.378- (Stress fracture, left toe(s))

Example: A patient presents to their primary care physician (PCP) with complaints of pain in the patient’s left foot. The physician orders X-rays of the foot to check for a fracture. After receiving the radiologist’s report, the physician diagnoses the patient with a stress fracture in his left foot. This is an initial encounter.

Solution: You should report code M84.375A (Stress fracture, left foot, initial encounter for fracture) on your claim.