 BREAKING DOWN FRACTURE
CODING……………... ....... 1

FRACTURE CODING
CONTINUED……… ............ 2
 LONG BONE
DIAGRAM……… ............... 2
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PATIENTS WITH HEART VALVE
DAMAGE………………2
Coding
Insight
Vol. 3 June 2012
Breaking Down Fracture Coding
Introduction
One in three adults aged 65 and older fall
per year in the United States, many
resulting in fracture injuries. Fracture types
can vary considerably, as can the codes
required to describe the fractures
accurately. Prior to coding any fracture,
make sure to classify the type of fracture
appropriately. Keep in mind the type of
encounter and whether or not it is the
initial episode of care treatment or a
follow-up visit.
Closed vs. Open Fractures
A closed fracture is a broken bone that does
not penetrate the skin. The following is a
list of the various types of closed fractures:
comminuted, depressed, elevated, fissured,
fracture NOS (not otherwise specified),
greenstick, impacted, linear, simple, slipped
epiphysis, and spiral. A fracture not
indicated as closed or open should be
classified as closed.
An open fracture has an open wound in the
skin associated with the broken bone. The
following is a list of terms that can be used
to describe an open fracture: compound,
infected, missile, puncture, with foreign
body.
To be classified as an open fracture, the
opening must correspond with the fracture.
The documentation may indicate the
patient has a fracture and a laceration at
the fracture site. If the laceration is
superficial and does not communicate with
the fracture, the two should be classified
separately with one code for the closed
fracture and another for the laceration.
Traumatic Fractures
Traumatic fractures are classified to ICD9-CM categories 800 to 829. The threedigit category code identifies the bone
involved. The fourth digit identifies
whether the fracture was open or
closed. If the documentation does not
provide specificity, the fracture is
classified as closed. The fifth digit
specifies which part of the bone is
fractured. When a patient is receiving
active treatment, you should code acute
fracture codes. Examples of active
treatment are: emergency department
encounter, surgical treatment, and
evaluation and treatment by a new
physician.
Nontraumatic or Pathological fracture
A nontraumatic or pathological fracture
is the break of a diseased or weakened
bone without any identifiable trauma or
following a minor injury that would not
ordinarily break a healthy bone. The
following terms are synonymous with
pathological fracture: insufficiency
fracture, spontaneous fracture,
nontraumatic fracture, and
nontraumatic compression fracture.
Underlying causes of pathological
fractures can include osteoporosis,
metastatic bone tumor, osteomyelitis,
Paget’s disease, disuse atrophy,
Additional Coding Tips...
• Traumatic fractures are classified
to ICD-9-CM categories 800829.
• A pathological fracture is
classified to code 733.1X, with
the fifth digit identifying the
fracture site. Use an additional
code to identify the underlying
condition.
• Malunion implies that bony
healing has occurred but the
fracture fragments are in poor
position. Code 733.81.
• Nonunion implies that no
healing has occurred between
fracture parts. Code 733.82.
• Stress fractures are tiny cracks in
a bone caused by repetitive
application of force, often by
overuse. Code from subcategory
733.9X.
• Late effect of a fracture is the
residual effect after the acute
phase of the injury has
terminated. Generally requires
two codes, the condition or
nature of the late effect
sequenced by the late effect
code, 905.X.
Y0071_12_16173_I_10/24/2012
Fracture coding cont…
hyperparathyroidism, and
nutritional or congenital
disorders. However, the fact
that the patient has a boneweakening condition does not
mean the fracture is pathologic.
Only the physician can
determine whether the fracture
is considered traumatic or
pathologic. Do not assign a code
for a traumatic fracture with a
code for a pathologic fracture at
the same site. The physician’s
documentation must be
carefully reviewed to determine
the correct diagnosis.
Compression Fractures
A compression fracture is the
collapse of a vertebra and may
be considered traumatic or
pathologic. Review the medical
record to determine whether
there was significant trauma to
cause the compression fracture.
Aftercare
Test Your Knowledge
Aftercare codes for healing
traumatic fracture (V54.1X),
healing pathologic fracture
(V54.2X), and other orthopedic
aftercare (V54.8X- V54.9) are
used for encounters of fracture
care after the patient has
completed active treatment
and is receiving routine care for
the fracture during the healing
and recovery phase. The
following are examples of
fracture aftercare: cast change
or removal, removal of external
or internal fixation device,
medication adjustment, and
follow up visits following
fracture treatment.
1. What term is defined as
“porous bones.” It is a disease
that leads to bone mass
reduction which can result in
fractures after minimal trauma.
Personal History of Fracture
Personal histories of
pathological (V13.51), stress
(V13.52), or traumatic fractures
(V15.51) are separately
classified because a patient
with such a history is at much
higher risk of repeat fracture to
the same site. Personal history
of pathological (healed) fracture
(V13.51) may be used in
addition to osteoporosis codes
733.00-733.09.
LONG BONE DIAGRAM
________________
2. An elderly patient falls while
walking down the stairs in her
home. After reviewing the xray, the physician’s final
diagnoses is a fracture of the
hip. What are the correct
diagnosis codes?
___________________
3. A patient got his cast wet, it
now needs replaced. What is
the correct diagnosis code?
___________________
Test Your Knowledge Answers:
1. Osteoporosis
Long bones are made up of 3 primary
areas:
2. 820.8- Fracture of hip (NOS),
1.
2.
E880.9- Accidental fall on or from
stairs or steps, and
E849.0- Home accidents
3. V54.89- Other orthopedic
aftercare
3.
Diaphysis or midshaft of the bone
Epiphysis, or end of the bone
a.
Proximal- end of the bone
that is closest to the head of
the body
b. Distal- the end of the bone
that is farthest from the head
of the body
Metaphysis, which lies next to the
epiphysis
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Official ICD-9-CM Coding Guidelines 2012
Following online resources:
http://www.fortherecordmag.com
http://health-information.advanceweb.com
http://www.bing.com/health/article/mayo-MADS00556
http://www.aafp.org
Y0071_12_16173_I_10/24/2012