Radiology Coding Alert

Check location, fracture type, and episode of care.

ICD-10 will offer a plethora of codes for fractures. This will make coding for fractures more challenging. You can meet these challenges by adopting a simple stepwise approach for coding fractures. 

Make note of the following mandatory anatomical and diagnostic details to code a fracture in ICD-10:

• Anatomic site on bone (proximal, shaft, distal)

• Laterality (right or left)

• Fracture Type (displaced, non-displaced, open or closed; if open there are 3 more subsets to choose from)

• Episode of care (initial, subsequent, or sequela).

When gathering these details, keep the following steps in mind to pinpoint the best diagnosis.

Step 1: Record Every Single Detail

Let’s walk through some examples to explain how you’ll choose the best fracture diagnosis code.

Example 1: Your physician documents the diagnosis as “fracture radius shaft.”

ICD-9 coding: With this information you can comfortably code 813.21 (Fracture of radius and ulna, shaft closed, radius alone).

In ICD-10, we have to code it with the addition of laterality, the fracture type, and the episode of care. ICD-10 offers 270 choices for this injury. For this example, imagine that you’re coding for the initial episode of care for a closed and non-displaced transverse type fracture on the patient’s right side.

You would report S52.324A, based on the following code details:

• S52.3 – Fracture shaft of radius

• S52.32 – Transverse fracture of shaft of radius

• S52.324 – Nondisplaced transverse fracture of shaft of RIGHT radius

• S52.324A – Nondisplaced transverse fracture of right radius, initial encounter for closed fracture.

Example 2: Your physician makes a diagnosis of fractured tibia. In ICD-9 coding, you would report this condition as 823.80 (Fracture of tibia and fibula, unspecified part, closed, tibia alone).

With ICD-10, you cannot code appropriately with so little information. For the sake of the example, suppose the details were: the right side, closed, displaced oblique type fracture, proximal tibia, initial encounter. You would code this particular diagnosis as S82.121A:

• S82.12 – Fracture of lateral condyle of tibia

• S82.121 – Displaced fracture of lateral condyle of right tibia

• S82.121A – Displaced fracture of lateral condyle of right tibia, initial encounter for closed fracture.

Step 2: Get Necessary Information for Payment

Not many conditions will have an option of “not otherwise specified” codes in ICD-10. Therefore, your provider will have to document all this additional information at the time of imaging - or you might need to query the surgeon’s office afterwards to get all the needed information.

Many radiologists include laterality in their notes and some will document whether a fracture is open or closed. It can be rare, however, to see all needed information in the clinical record regarding the patient’s diagnosis. Reminding your providers that they won’t get paid adequately under ICD-10 without those details could give them the incentive to better document their services.

Bonus: A good head start for preparing for ICD-10 would be to include specific and complete diagnosis information in your documentation. If you make this a habit, ICD-10 compliance will be easier and your claims will be completed with fewer questions from coders and fewer denials from payers.