Wiki if fracture is not listed as displaced or non, do we query?

[The Angel Of the South]

I had a practicode question about a fracture in which the report does not seem to specify displaced or nondisplaced, and I eventually remembered that the default is displaced. But in the real world, couldn't we just query the physician and find out? More generally, when we have one of these cases where there is a certain default rule if information isn't specified, why should we settle for it being unspecified? Why not query?

 

[csperoni]

Here's my 2 cents about query. A lot of it depends on the clinician you are sending the query to and your employers policies and expectations.
This would be 2 extreme examples that could occur in the real world:
1) You work 95% of your time for 1 provider. Your manager is a coder and understands the work involved. Quotas are more guidelines, and variances are acceptable. You have a rapport with the provider and speak on a weekly basis. The provider is respectful and knowledgeable. That provider might even appreciate your query not realizing the original documentation was insufficient and will respond with the additional necessary documentation within an hour.
2) You have a quota of 20 E/M services coded per hour. Your manager is not a coder and any day you fall below your 20/hour quota, your manager schedules a meeting with you to discuss why. You code for 50 providers in 10 different specialties in any given week. This provider treats queries as a bother and an interruption of their work. When a query is received, it will be a minimum of 10 days and 5 emails back and forth to have the amendment.
If you were coder in situation 2, if there is a default rule, odds are you will follow the default rule.

 

[Orthocoderpgu]

I had a practicode question about a fracture in which the report does not seem to specify displaced or nondisplaced, and I eventually remembered that the default is displaced. But in the real world, couldn't we just query the physician and find out? More generally, when we have one of these cases where there is a certain default rule if information isn't specified, why should we settle for it being unspecified? Why not query?

You would be wasting the providers time by asking the physician for this question. There is a reason why the default is "displaced". Most providers are very good at mentioning that a fracture is non-displaced because that does not happen as frequently. The biggest problem in orthopedic coding of fractures is that the providers document the anatomical location, and frequently leave out the type of fracture.

 

[The Angel Of the South]

Thanks, I had half guessed that: assume the default and don't bother the provider, and hope you're right.

What I hadn't figured out here is that the default rule is not arbitrary. That we assume displaced because the fracture usually is.