FRACTURE

CODING
ALERT

PPT by Ms Rani Jain

Fracture Treatment Isn’t One Size Fits All

Typical methods of care that an orthopedic physician may provide:

• Closed reduction is non-surgical manipulation of a fractured bone to restore
the bone to normal anatomic alignment.
• Percutaneous fixation involves the placement of a stabilizing device such as a
rod, plate, multiple wires, pins, or screws across a fractured bone, typically
under imaging guidance.
• Open reduction with internal fixation (ORIF) is an incisional procedure to
realign and fixate separated bone fragments.
• Closed treatment without manipulation involves fitting the patient to
appropriate materials for bone stabilization and weight bearing/non-weight
bearing function.
• Debridement of fractures- CPT codes 11010-11012 include prolonged
cleansing of the contaminated site, removal of all foreign or dead material
from the wound site, and irrigation of all tissue layers and exploration of soft
tissue injured. May be performed alone or with fracture care.
Fine Details Are Critical in Fracture Coding
• Initial fittings of casts, splints, strappings, and other materials are included in
the global service of fracture care.
• A fracture not indicated as open (or implied by the presence of a skin wound)
is considered closed.
• A fracture not indicated as nondisplaced is considered displaced.
• Additional intraoperative services may be bundled into fracture surgeries, such
as debridement, bone grafts, or old hardware removal.
• Internal fixation-Use of internal hardware such as plates, screws, nails, wires
• External fixation- Use of traction
• Did the provider use manipulation?
Look for key words like move, distract and realign
• Difference between a Closed and Open Fracture
Closed or Simple Fracture- The bone is broken, but the skin is not lacerated
Open or Compound Fracture- The skin maybe pierced by bone or by blow that
breaks the skin at the time of fracture. The bone may or may not be visible in the
wound.
• Specify the lateral side in each and every case
• Document type of fracture.
– Open
– Closed
– Pathologic
– Stress/Fatigue
– Displaced or nondisplaced
• Specify the location of the fracture.
– Head
– Shaft
– Distal
– Proximal
• Document the pattern
– Transverse
– Oblique
– Segmental
• Specify the encounter type.
– Initial (use seventh digit “A”)
– Subsequent (use seventh digit “D”)
– Sequela (use seventh digit “S”)
• Document the status in the post-op period at time of subsequent encounters.
– Routine healing
– Delayed healing
– Nonunion
– Malunion
Two type of fractures- Traumatic and non-traumatic(pathological)
• Eg. Of traumatic fracture are fall, blunt injury or a motor vehicle accident

A pathological fracture results from a break of a diseased or weakened

bone.
Causes of weakened bone include tumors, infection, and certain
inherited bone disorders
Pathologic fracture categories
• M80.0- (Age-related osteoporosis with current pathological
fracture)
• M80.8- (Other osteoporosis with current pathological fracture)
• M84.4- (Pathological fracture, not elsewhere classified)
• M84.5- (Pathological fracture in neoplastic disease)
• M84.6- (Pathological fracture in other disease)
7th character Types of encounter To be used

When the patient is receiving active

A, B, C Initial encounter for fracture treatment for the injury (e.g., surgical
treatment or emergency department
encounter).
D, E, F Subsequent encounter for fracture When the patient has received and
G, H, J with routine healing completed active treatment of the
K, M, N Subsequent encounter for fracture injury and is receiving routine care
P, Q, R with delayed healing during the healing or recovery phase
Subsequent encounter for fracture (e.g., cast change or removal,
with nonunion medication adjustment, removal of
Subsequent encounter for fracture external or internal fixation device, or
with malunion other aftercare and follow-up visits).

S Sequela For complications or conditions that

arise as a direct result of an injury (e.g.,
scar formation after a burn). When
using 7th character “S”, code both the
injury that caused the sequela and the
sequela itself, sequence the exact type
of sequela (e.g., scar) first, followed by
the injury code.
TYPES OF TRAUMATIC FRACTURES
THANK YOU !!