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Tip: Distinguish traumatic, pathologic fractures in ICD-10-CM

APCs Insider, May 4, 2012

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Coders will need additional details to code fractures with ICD-10-CM. For example, providers must document, in some form, whether a fracture is traumatic or pathologic.

A traumatic fracture is caused by some type of accident, fall, or other kind of force. For example, a traumatic fracture can occur during a motor vehicle accident or when a person is struck with a heavy object.

A pathologic fracture is a broken bone caused by disease. In ICD-9-CM, coders must choose from only eight pathologic fracture codes. ICD-10-CM expands this code selection to more than 150.
So how do coders differentiate the two types of fractures? Sometimes, it's quite obvious. If a patient fractured a leg after falling off a roof while replacing shingles, this is a clear example of a traumatic fracture.

However, an individual who leaned over to retrieve a glass and broke a vertebra likely suffered a pathologic fracture. Leaning over generally does not produce enough force to break a healthy bone.

If a patient suffers a fall or trauma that results in a fracture, don't automatically assume the fracture is traumatic. If the force from a fall or trauma is insufficient to break a healthy bone, the fracture is pathologic.

The tip is adapted from “Fracture coding in ICD-10-CM requires greater specificity” in the May Briefings on APCs.

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