Radiology Coding Alert

First confirm type and then look to morphology and laterality.

When reporting ICD-10 codes for open fractures of the patella, you may feel lost in a plethora of codes. Here is how you can narrow down your choices to pick up the most accurate diagnosis codes.

Unlike ICD-9, ICD-10 offers a wide range of codes for open patellar fractures. The ICD-9 code for an open fracture of patella is 822.1 (Open fracture of patella). When coding for open fractures of the patella in ICD-10, you will need to first check what was the type of fracture. Similar to the ICD-10 codes for closed fractures of patella, morphology and laterality are important, but only when you know what was the type of open fracture. You may lose payment if you miss this initial important step.

Confirm Type in Open Fracture

To select the appropriate codes, you’ll need to determine whether the open fracture is type I, II, or III.

Check If Fracture Is Longitudinal Or Transverse

Once you have determined the type of open fracture of the patella, the next step is to confirm the morphology and displacement. Also, you will maintain focus for the right or the left side being involved. The simplest possible morphological variant in a fractured patella is the breaking of the bone into two pieces with the fracture line being either longitudinal or transverse.

For displaced longitudinal open fracture of right patella, you report S82.021B (Displaced longitudinal fracture of right patella, initial encounter for open fracture type I or II) or S82.021C (Displaced longitudinal fracture of right patella, initial encounter for open fracture type IIIA, IIIB, or IIIC). For the same on the left side, you report S82.022B (Displaced longitudinal fracture of left patella, initial encounter for open fracture type I or II) or S82.022C (Displaced longitudinal fracture of left patella, initial encounter for open fracture type IIIA, IIIB, or IIIC). However, when your radiologist does not specify the side of the displaced longitudinal open fracture in the patella, you report S82.023B (Displaced longitudinal fracture of unspecified patella, initial encounter for open fracture type I or II) or S82.023C (Displaced longitudinal fracture of unspecified patella, initial encounter for open fracture type IIIA, IIIB, or IIIC).

You follow the same set of rules for a nondisplaced longitudinal fracture of the patella. You can select the appropriate code from the following:

• S82.024B (Nondisplaced longitudinal fracture of right patella, initial encounter for open fracture type I or II)
• S82.024C (Nondisplaced longitudinal fracture of right patella, initial encounter for open fracture type IIIA, IIIB, or IIIC)
• S82.025B (Nondisplaced longitudinal fracture of left patella, initial encounter for open fracture type I or II)
• S82.025C (Nondisplaced longitudinal fracture of left patella, initial encounter for open fracture type IIIA, IIIB, or IIIC)
• S82.026B (Nondisplaced longitudinal fracture of unspecified patella, initial encounter for open fracture type I or II)
• S82.026C (Nondisplaced longitudinal fracture of unspecified patella, initial encounter for open fracture type IIIA, IIIB, or IIIC)

When your radiologist documents a transverse open fracture of the patella, you can adopt the same stepwise approach of determining the type, displacement, and side, to be able to navigate to the right code. You may choose from codes in the S82.031B (Displaced transverse fracture of right patella, initial encounter for open fracture type I or II) to S82.036C (Nondisplaced transverse fracture of unspecified patella, initial encounter for open fracture type IIIA, IIIB, or IIIC) range.

Several Fractured Pieces? Report Comminuted Fracture

Your radiologist may document a comminuted fracture of the patella when the X-ray shows that the bone is fragmented into three or more pieces.

For displaced comminuted fractures of type I or II, you report code S82.041B (Displaced comminuted fracture of right patella, initial encounter for open fracture type I or II) or S82.042B (Displaced comminuted fracture of left patella, initial encounter for open fracture type I or II) depending upon whether the right or the left patella was fractured.

Similarly, for type III fractures, you select from S82.041C (Displaced comminuted fracture of right patella, initial encounter for open fracture type IIIA, IIIB, or IIIC) or S82.042C (Displaced comminuted fracture of left patella, initial encounter for open fracture type IIIA, IIIB, or IIIC).

When your radiologist does not document the side of the displaced comminuted fracture, you report S82.043B (Displaced comminuted fracture of unspecified patella, initial encounter for open fracture type I or II) for type I or type II fractures and code S82.043C (Displaced comminuted fracture of unspecified patella, initial encounter for open fracture type IIIA, IIIB, or IIIC) for the type III fractures.

If however your radiologist documents a nondisplaced open comminuted fracture of the patella, you select from codes S82.044B (Nondisplaced comminuted fracture of right patella, initial encounter for open fracture type I or II), S82.044C (Nondisplaced comminuted fracture of right patella, initial encounter for open fracture type IIIA, IIIB, or IIIC), S82.045B (Nondisplaced comminuted fracture of left patella, initial encounter for open fracture type I or II), or S82.045C (Nondisplaced comminuted fracture of left patella, initial encounter for open fracture type IIIA, IIIB, or IIIC), depending upon the type and laterality of the fracture.

If you fail to confirm the laterality of the fracture in the clinical note, you can turn to S82.046B (Nondisplaced comminuted fracture of unspecified patella, initial encounter for open fracture type I or II) for fracture type I or II or S82.046C (Nondisplaced comminuted fracture of unspecified patella, initial encounter for open fracture type IIIA, IIIB, or IIIC) for fracture type III.

Remember: When ICD-10 goes into effect on Oct. 1, 2014, 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.

Editor’s note: Read about reporting of open osteochondral and unspecified open fractures of patella in the next issue. For closed fractures of patella refer to Radiology Coding Alert, Vol.15n9.