Wiki Atraumatic Fracture

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mcdream

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Hi all,
How to code for an atraumatic fracture when the site of the atraumatic fracture is not indexed under fracture > nontraumatic?

Example: Closed fracture of one rib, left side with routine healing likely due to osteoporosis
Index: fracture > nontraumatic - rib not listed
Index: fracture > pathological > rib M84.48 would not Index: fracture > traumatic > rib S22.32XD unless minimal trauma documented?

Atraumatic Fracture Def: fracture occurs with no trauma or minimal trauma that would not normally be expected to result in a fracture; can be stress fx, fatigue fx, insufficiency fx.
TIA
 
Would need to see more documentation to make a determination. I agree you can't code to osteoporosis due to the word "likely". It has to be definitively stated.
 
mcdream said:
Can't code to M80.- as fracture was not confirmed as due to osteoporosis "likely due to osteoporosis"
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I would use the M80 code in this instance - the pathological fracture codes will take priority even if it's not definitely stated that it was due to the osteoporosis. The scenario you describe, in my opinion, clearly fits this situation described in the ICD-10 guidelines C.13.d.2:

A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone.
 
If the patient has known osteoporosis and rib fracture "likely due to osteoporosis" then code M80.0A- guideline C.13.d.2

But if the patient has not been previously diagnosed with osteoporosis only suspected to have osteoporosis and that the rib fracture is "likely due to osteoporosis" then M84.48 would be appropriate?
 
mcdream said:
If the patient has known osteoporosis and rib fracture "likely due to osteoporosis" then code M80.0A- guideline C.13.d.2

But if the patient has not been previously diagnosed with osteoporosis only suspected to have osteoporosis and that the rib fracture is "likely due to osteoporosis" then M84.48 would be appropriate?
Click to expand...
I would interpret 'likely due to osteoporosis' to mean that the fracture was 'likely caused by the patient's osteoporosis', not to mean that the patient 'likely has osteoporosis', but I see that this could be ambiguous and may require a query to the provider. However, without additional information, I would still use the M code rather than a T code. If the provider has stated 'atraumatic', then this is clearly not a traumatic fracture and shouldn't be coded as one. A pathological fracture, by definition, is one that is caused by a chronic or underlying disease and not by trauma. So even if osteoporosis itself is not certain, I think it would be more correct to classify it as a pathological fracture than not. In other words, if it's not traumatic, then I would consider it pathological by default - it's only the underlying disease that's in doubt, not the fact that it's a pathological fracture.
 
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I agree with Thomas. Mcdream, if you would like to attach doctor's note for the visit, we might be able to find more info about this patient and clarify the diagnosis needed for the claim.
 
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