Radiology Coding Alert

Question: A 24-year-old patient comes into the emergency department (ED) presenting severe acute pain in the right hand after a puck hit their hand while playing hockey. The documentation includes a note that the patient mentioned undergoing surgery four weeks prior to this encounter to repair a right wrist fracture. A radiologist captures two X-ray views of the patient’s hand and notices pins in the patient’s wrist in the X-rays. After evaluating the X-rays, the physician diagnosed the patient with closed displaced fractures of the second, third, and fourth metacarpal (MCP) shafts.

Do I need to code the pins in the patient’s wrist?

Vermont Subscriber

Answer: No, you do not have to code the pins in the patient’s wrist. The physician’s notes include a recent wrist surgery where the surgeon installed pins to aid in the healing. The pins were placed intentionally for therapeutic purposes, so they’re considered an implant under the Radiology section guidelines in the CPT^® code set. Additionally, you shouldn’t report the pins in the wrist since their presence is unrelated to the patient’s current condition.

The physician diagnosed the patient with fractures of the second, third, and fourth MCP shafts. When you look up Fracture, traumatic > metacarpal in the Alphabetic Index of the ICD-10-CM code set, you’ll find each of those metacarpals has a separate entry section, yet they all reference S62.32- (Displaced fracture of shaft of other metacarpal bone) for shaft fracture. In the tabular list, you’ll discover S62.32- carries a 6th character required icon to help you specify the metacarpal number and laterality. Plus, the specific codes require 7th characters, so you can indicate open or closed fractures and whether the visit is an initial encounter, subsequent encounter, or sequela. Since the patient presented to the ED for the injury, you’ll assign 7th character A to report each diagnosis as an initial encounter for a closed fracture.

The codes you’ll assign for the metacarpal shaft fractures are:

• S62.320A (Displaced fracture of shaft of second metacarpal bone, right hand, initial encounter for closed fracture)
• S62.322A (Displaced fracture of shaft of third metacarpal bone, right hand, initial encounter for closed fracture)
• S62.324A (Displaced fracture of shaft of fourth metacarpal bone, right hand, initial encounter for closed fracture)

Lastly, you’ll assign 73120 (Radiologic examination, hand; 2 views) to report the X-rays of the patient’s hand.