Health Information Management

Focus on fracture coding changes in ICD-10-CM

HIM-HIPAA Insider, August 11, 2014

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The section of codes that expanded most in ICD-10-CM involves orthopedic injuries, especially fractures.

In ICD-9-CM, coders may only have two choices for a particular fracture. For example, a fracture of the shaft of the humerus only has two possible ICD-9-CM codes—812.21 for a closed fracture and 812.31 for an open fracture.
In ICD-10-CM, fractures of the shaft of the humerus fall under subcategory S42.3-, which includes eight subdivisions that specify the type of fracture, such as greenstick or comminuted. Each subcategory includes three codes to indicate laterality—left, right, or unspecified. Five of the categories further specify whether the fracture is displaced or non-displaced.
All of the codes in subcategory S42.3- require a seventh character to identify the encounter. Coders have seven options when it comes to seventh characters in S42.3-.
ICD-10-CM does include two defaults for fractures. If a fracture is not documented as displaced or nondisplaced, code it as displaced. If a fracture is not documented as open or closed, code it as closed.
The most difficult aspect in coding fractures is that a fracture not documented as displaced or non-displaced is automatically considered displaced, says Kristi Stanton, RHIT, CCS, CPC, CIRCC, AHIMA-approved ICD-10-CM/PCS trainer, AHIMA ICD-10 ambassador, and senior consultant with the Haugen Consulting Group in Denver.
"Just know that it is assumed, unless the physician specifically tells us that it's non-displaced, that that fracture was not in a normal position," Stanton says.
Continue reading "Focus on fracture coding changes in ICD-10-CM" on the HCPro website. Subscribers to Briefings on Coding Compliance Strategieshave free access to this article in the August issue.



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