Radiology Coding Alert

Question: What is the seventh character significance in diagnosis codes for pathologic fracture? Do these differ for traumatic fracture diagnosis codes?

New Mexico Subscriber

Answer: When reporting codes in the pathological or stress fracture category (M84.3-M84.6), you need to be specific for the seventh character. Below is what these characters mean:

• A – Initial encounter for fracture
• D – Subsequent encounter for the fracture with routine healing
• G – Subsequent encounter for the fracture with delayed healing
• K – Subsequent encounter for fracture with nonunion
• P – Subsequent encounter for fracture with malunion
• S – Sequela

For instance, you would use the seventh character ‘A’ at the first encounter with a physician. This includes surgical treatment, ED encounter, and treatment by a new physician.

You would use the seventh character D for follow-up visits. Examples of subsequent treatment include cast change or removal, removal of external or internal fixation device, medication change, other follow-up visits.

Traumatic Fractures Seventh Characters Differ: Seventh characters assigned in this chapter are identified at the category level to indicate initial encounter, subsequent encounter, or sequela.

Fracture seventh characters are expanded to include:

A – initial encounter for closed fracture

B – initial encounter for open fracture

D – subsequent encounter for fracture with routine healing

G – subsequent encounter for fracture with delayed healing

K – subsequent encounter for fracture with nonunion

P – subsequent encounter for fracture with malunion

S – sequela

Some fracture categories provide for seventh characters to designate the specific type of open fracture (these designations are based on the Gustilo open fracture classification):

B – initial encounter for open fracture type I or II (open NOS or not otherwise specified)

C – initial encounter for open fracture type IIIA, IIIB, or IIIC

E – subsequent encounter for open fracture type I or II with routine healing

F – subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing

H – subsequent encounter for open fracture type I or II with delayed healing

J – subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing

M – subsequent encounter for open fracture type I or II with nonunion

N – subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion

Q – subsequent encounter for open fracture type I or II with malunion

R – subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion

Make certain that you know what seventh character to apply to your fracture care code.