Health Information Management

Seventh characters for open fractures

HIM-HIPAA Insider, June 16, 2014

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A patient comes into the ED following an automobile accident. The physician documents that the patient has an open, displaced fracture of the lateral condyle of the right tibia. The physician also documents that the patient suffered an associated arterial injury requiring repair and this is the patient’s first encounter.

We can code that injury very easily in ICD-9-CM. In fact, we have a lot more information than we really need. In ICD-9-CM, we would report 823.10 (fracture of upper end of the tibia, open).
In ICD-10-CM, we need a little more information, almost all of which we have. We know the:
  • Laterality (right)
  • Specific site (lateral condyle)
  • Encounter (initial)
  • Open
  • Displaced
With that, we can get to S82.121- (displaced fracture of the lateral condyle of right tibia), but our code isn’t quite complete. We need a seventh character for the encounter. We see 16 possible seventh characters for fractures of the lower leg. Most fractures don’t have that many options, by the way.
We can narrow our choices down to two:
  • B, initial encounter for open fracture type I or II
  • C, initial encounter for open fracture type IIIA, IIIB, or IIIC
The types refer to the Gustilo-Anderson classification for open fractures (You can find out more about Gustilo-Anderson classifications here).
The Gustilo-Anderson system classifies the amount of soft tissue injury associated with an open fracture.
Our ED physician documented that the patient suffered an arterial injury that required a repair, which translates to a type IIIC fracture on the Gustilo-Anderson classification. However, the physician didn’t say specify the type, so we can’t use C as our third character.
“The physician has to document the type,” says Kim Carr, RHIT, CCS, CDIP, CCDS, AHIMA-approved ICD-10-CM/PCS trainer, director of clinical documentation for HRS in Baltimore. “You can’t go by the description.”
That’s only one of the great pieces of information Kim and Kristi Stanton, RHIT, CCS, CPC, CIRCC, senior consultant with the Haugen Group, shared during our webcast, ICD-10-CM Orthopedics: What You Need to Know for Fractures, Sprains, and Dislocations. If you missed it live, no worries. You can still order an on-demand version of the program. And you can still earn AAPC and AHIMA credits!
This article originally appeared on HCPro’s ICD-10 Trainer blog.

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