• E-mail
• Print
• RSS

Coding tip: Understand essential fracture information

Ambulatory Surgery Reimbursement Update, October 2, 2007

Coders code fractures of specified sites individually by site in accordance with both the requirements within categories 800-829 in the ICD-9-CM diagnosis coding book, and the level of detail furnished by the medical record. Medicare does not cover most fracture care in an ASC setting. Only when the procedure code appears on the Medicare Grouper List, will Medicare reimburse that procedure in the ASC facility setting by Medicare.

When coding fractures, consider the following:

• Where the fracture or dislocation is located
• If the treatment is open or closed
• If manipulation is involved
• If traction is applied
• If fixation is applied
• If soft tissue closure is performed
• If there were there any grafts used

The term "manipulation" refers to the "attempted" reduction or restoration of a fracture or joint dislocation to its normal anatomical alignment. When a fracture requires closed reduction followed by an open reduction procedure in the same encounter, only the open reduction service is billed. Closed fractures have no open wound into the skin. Fractures are considered "closed" unless specified "open" in the medical record.

This tip is brought to you by Ellis Medical Consulting, Inc.

• E-mail to a Colleague
• Print
• RSS
• Archive