Radiology Coding Alert

Hint: Morphology and laterality are your best guides.

Don’t let elaborate ICD-10 code descriptors confuse your patellar fracture coding. As in ICD-9, you’ll retain the focus on open and closed fractures. When reporting a closed fracture of the patella, you submit ICD-9 code 822.0 (Closed fracture of patella). The corresponding ICD-10 code will depend upon the morphology and laterality of the closed fracture.

Hit Right Codes for Longitudinal and Transverse Fractures

When reporting closed fracture of patella, you check for the longitudinal or transverse fractures and then check for the displacement. For displaced longitudinal closed fractures of the patella, you report code S82.021A (Displaced longitudinal fracture of right patella, initial encounter for closed fracture), S82.022A (Displaced longitudinal fracture of left patella, initial encounter for closed fracture), or S82.023A (Displaced longitudinal fracture of unspecified patella, initial encounter for closed fracture) depending upon whether your radiologist located the fracture in the left or right patella.

Similarly for nondisplaced longitudinal closed fracture of patella, you report codes S82.024A (Nondisplaced longitudinal fracture of right patella, initial encounter for closed fracture), S82.025A (Nondisplaced longitudinal fracture of left patella, initial encounter for closed fracture), or S82.026A (Nondisplaced longitudinal fracture of unspecified patella, initial encounter for closed fracture).

You follow the same rules for the displaced and nondisplaced closed transverse fracture of the patella. Depending on laterality  for these fractures, you choose from codes S82.031A (Displaced transverse fracture of right patella, initial encounter for closed fracture), S82.032A (Displaced transverse fracture of left patella, initial encounter for closed fracture), S82.033A (Displaced transverse fracture of unspecified patella, initial encounter for closed fracture), S82.034A (Nondisplaced transverse fracture of right patella, initial encounter for closed fracture), S82.035A (Nondisplaced transverse fracture of left patella, initial encounter for closed fracture), S82.036A (Nondisplaced transverse fracture of unspecified patella, initial encounter for closed fracture).

Capture Comminuted and Osteochondral Fractures with Specificity

Your radiologist may report that the patella was broken in three or more pieces. In this case, you capture codes for comminuted fracture depending upon whether or not the fracture was displaced or not. Also make sure to ascertain if the fracture was on the right or left patella. For displaced comminuted fracture, you chose from S82.041A (Displaced comminuted fracture of right patella, initial encounter for closed fracture) or S82.042A (Displaced comminuted fracture of left patella, initial encounter for closed fracture). For nondisplaced comminuted fracture, you chose from codes S82.044A (Nondisplaced comminuted fracture of right patella, initial encounter for closed fracture) or S82.045A (Nondisplaced comminuted fracture of left patella, initial encounter for closed fracture).

However, when your radiologist does not specify the side of the comminuted fracture, you select code S82.043A (Displaced comminuted fracture of unspecified patella, initial encounter for closed fracture) or S82.046A (Nondisplaced comminuted fracture of unspecified patella, initial encounter for closed fracture) depending upon whether the fracture was displaced or nondisplaced.

Your radiologist may pick up a fracture in the articular cartilage and the underlying bone in the patella. Such a fracture is called an osteochondral fracture.

Depending on whether the fracture is in the right or left patella and if the fracture is a displaced or nondisplaed one, you would report one of the following codes:

• S82.011A (Displaced osteochondral fracture of right patella, initial encounter for closed fracture)
• S82.012A (Displaced osteochondral fracture of left patella, initial encounter for closed fracture)
• S82.013A (Displaced osteochondral fracture of unspecified patella, initial encounter for closed fracture)
• S82.014A (Nondisplaced osteochondral fracture of right patella, initial encounter for closed fracture)
• S82.015A (Nondisplaced osteochondral fracture of left patella, initial encounter for closed fracture)
• S82.016A (Nondisplaced osteochondral fracture of unspecified patella, initial encounter for closed fracture)

Do Not Miss Other Fractures

For any other type of closed patellar fracture, you report code S82.091A (Other fracture of right patella, initial encounter for closed fracture), S82.092A (Other fracture of left patella, initial encounter for closed fracture), or S82.099A (Other fracture of unspecified patella, initial encounter for closed fracture).

When your radiologist does not specify the type of closed fracture, you report S82.001A (Unspecified fracture of right patella, initial encounter for closed fracture) for right patella and S82.002A (Unspecified fracture of left patella, initial encounter for closed fracture) for the left patella.

Editor’s note: Follow up for reporting of open fractures of patella in the next issue of Radiology Coding Alert, Vol.15n10.