Radiology Coding Alert

Let this helpful graphic connect the fracture ICD-9/anatomy dots.

Students Like The Professor To Teach Complex Hypotheses is just one of the mnemonic devices to help you remember the carpal bones: Scaphoid, Lunate, Triquetral, Pisiform, Trapezium, Trapezoid, Capitate, Hamate. (And you can find plenty of racier options without looking too hard.)

But keeping this chart nearby is the easiest way to pair those bones with their proper fracture diagnosis codes.

Fourth digit options: Your fourth digit options are the same for 814.xx-817.x: 0 (closed) when the bone doesnt break the skin and 1 (open) when the bone breaks the skin.

Key: ICD-9 guidelines instruct you to report a closed code when documentation doesnt indicate closed or open.

814.xx -- Fracture of carpal bone(s)

" 814.x0 -- & carpal bone, unspecified

" 814.x1 -- & navicular (scaphoid) of wrist

" 814.x2 -- & lunate (semilunar) bone of wrist

" 814.x3 -- & triquetral (cuneiform) bone of wrist

" 814.x4 -- & pisiform

" 814.x5 -- & trapezium bone (larger multangular)

" 814.x6 -- & trapezoid bone (smaller multangular)

" 814.x7 -- & capitate bone (or magnum)

" 814.x8 -- & hamate (unciform) bone

" 814.x9 -- & other.

816.xx -- Fracture of one or more phalanges of hand

" 816.x0 -- & phalanx or phalanges, unspecified

" 816.x1 -- & middle or proximal phalanx or phalanges

" 816.x2 -- & distal phalanx or phalanges

" 816.x3 -- & multiple sites.

815.xx -- Fracture of metacarpal bone(s)

" 815.x0 -- & metacarpal bone(s), site unspecified

" 815.x1 -- & base of thumb (first) metacarpal

" 815.x2 -- & base of other metacarpal bone(s)

" 815.x3 -- & shaft of metacarpal bone(s)

" 815.x4 -- & neck of metacarpal bone(s)

" 815.x9 -- & multiple sites of metacarpus.

817.x -- Multiple fractures of hand bones.

Important: Section I.C.17.b of the ICD-9 official guidelines explains that you should report fractures of specified sites individually. ICD-9 intends multiple fracture codes (817.x) for use in triage for multiple  trauma, with the expectation that the patient was transferred before definitive diagnoses could be made or when the reporting limits the number of codes that can be listed.