Wiki Path Fx

[BlakeCarswell82]

This has happened multiple times.

We have a client who sends us the documentation of 733.13 on the facesheet (which is pathological fracture of the spine). When called to confirm the diagnosis because all we are getting is the code and our pathologist doesn't see any particular path reasons for a fx, the nurse says these patients have collapsed spinal vertebrae. When I look up fracture, vertebra, collapse, it says the code is 733.13. She said that if the patient has fallen, the fall should not have resulted in a traumatic fracture, and the client suspects that the fracture is due to pathological reasons.

However, my pathologists do not always see a disease process and do not diagnose it as a pathological fracture. In fact, I have no diagnosis at all besides the 733.13 on the facesheet. I have no signs/symptoms to go back to.

Whose diagnosis is binding in these cases? I can justify vertebral spine fracture, but I can't justify that it is from pathological reasons. There is no DEXA scan on file. There is no documentation to "prove" their claim.

Path Fxs confuse me!

 

[bbooks]

I found the information in this link helpful: http://www.fortherecordmag.com/archives/ftr_111408p28.shtml.

In the article is says, "A nontraumatic or pathological fracture is a break of a diseased or weakened bone without any identifiable trauma or following a minor injury that would not ordinarily break a healthy bone.....Only the physician can determine whether the fracture is considered traumatic or pathologic, and physician documentation must be obtained to clarify the diagnosis."

So, it seems that if the patient's physician believes the injury should not have resulted in a fracture, even if the pathology is negative, it is still correct to code for pathological fracture.

In these cases, I use 733.13 even if the pathology is negative.

 

[mitchellde]

It is probably just a fatigue fracture of the vertebrae which I do not believe we have a specific code for in ICD-9 which is why the book will reference you to the 733.13 code. However ICD-10 CM does have a code for this M48.4- , but until then you only have the 733.13 to work with.