Radiology Coding Alert

Bone up on the Gustilo fracture classification.

Under ICD-10, fracture coding is serious business. The level of detail required to choose the most specific code is much more stringent than under ICD-9. Prepare your practice with this Colles' fracture coding primer.

ICD-9-CM Code

• 813.41, Colles' fracture closed
• 813.51, Colles' fracture open

ICD-10-CM Codes

• S52.531-, Colles' fracture of right radius
• S52.532-, Colles' fracture of left radius
• S52.539-, Colles' fracture of unspecified radius

Choose the appropriate 7th character from these options:

• A, initial encounter for closed fracture
• B, initial encounter for open fracture type I or II/initial encounter for open fracture NOS
• C, initial encounter for open fracture type IIIA, IIIB, or IIIC

ICD-9-CM coding rules: ICD-9 gives you one coding option for a closed Colles' fracture and a second option for an open Colles' fracture. If the physician doesn't specify open or closed, you should use the code for a closed fracture.

ICD-10-CM changes: ICD-10 expands your Colles' fracture code requirements with distinctions based on whether the patient has a closed fracture or has an open fracture classified as type I, II, IIIA, IIIB, or IIIC (based on the Gustilo open fracture classification). Note that if the open fracture type isn't specified, you should use seventh character B. Just as with ICD-9, if documentation doesn't indicate open or closed, you should report a closed code.

Documentation: Knowing that the patient is presenting for an initial encounter is important to proper ICD-10 coding. A, B, and C, which all describe an initial encounter, are just three of many seventh character options. ICD-10 supplies additional options for subsequent and sequela encounters, too. Those divisions get even more specific with options related to routine healing, delayed healing, nonunion, or malunion. These codes cross to ICD-9 aftercare and late effect codes.

Coder tips: ICD-9 includes Smith's fracture under closed Colles' fracture code 813.41. In contrast, ICD-10 gives Smith's fracture its own codes:

• S52.541-, Smith's fracture of right radius
• S52.542-, Smith's fracture of left radius
• S52.549-, Smith's fracture of unspecified radius

Remember: When ICD-10-CM goes into effect, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update. The proposed implementation date is Oct. 1, 2014, but the final rule has not been announced.