Radiology Coding Alert

Count, laterality, and seventh character details are equally important to make your way to the right code.

Fractures in the ribs are common and so are errors in diagnosis coding for these fractures. According to the American Association for the Surgery of Trauma (http://www.aast.org/rib-fractures), approximately 10% of all patients admitted for blunt chest trauma have one or more rib fractures. In a patient with trauma to thorax, your physician may do an X-ray of the chest to detect any possible fractures of the ribs. Fractures in the ribs can typically occur in one or more ribs on the right or left sides.

Follow this stepwise guide to the most accurate codes for rib fractures.

1. Keep a count of fractured ribs.

The first step to coding a rib fracture is to determine who many ribs were fractured. You have specific codes for single and multiple rib fractures.

2. Laterality is key to rib fractures.

The next step is to confirm the laterality of the rib fracture. Read the clinical note and find out if fracture was diagnosed in one or more ribs on the right or the left side.

3. Don’t forget the seventh character.

There is also a seventh character that describes details for the fracture. You choose the seventh character depending upon the initial (for closed or open fracture) or subsequent (routine or delayed healing or non-union), or sequelae to the fracture.

For fracture of the single rib on the right side, you submit code S22.31 (Fracture of one rib, right side) and for that on the left side, you submit code S22.32 (Fracture of one rib, left side). However, if our physician does not specify the laterality for the fractured rib, you submit code S22.39 (Fracture of one rib, unspecified side).

Similarly, for multiple fractures of the ribs on the right, left, and unspecified sides, you submit codes S22.41 (Multiple fractures of ribs, right side), S22.42 (Multiple fractures of ribs, left side), and S22.49 (Multiple fractures of ribs, unspecified side), respectively. Additionally, you have a code S22.43 (Multiple fractures of ribs, bilateral) for multiple fractures on both the right and left sides.

Each of these codes has further details described by seventh characters. Table 1 lists the seventh character details for codes for fracture of one rib. Similar seventh characters apply to codes of series S22.41, S22.42, S22.43, and S22.49, respectively.

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