What You Need to Know About Fracture Codes in ICD-10

In the world of ICD-10-CM, details are everything, which means you have to collect more information to select the proper diagnosis code. For orthopedics, fractures and other types of injuries are among the most common diagnoses – but they are also the most detail-intensive from an ICD-10 perspective. In this article, we’ll look at the information required for ICD-10 coding in the orthopedic sphere and how you can alter your workflow to adapt.

Fracture Guidelines in Medical Coding

Fracture care is an orthopedic mainstay, and you’ll need to collect quite a few data points to create a high-specificity ICD-10 code for a fracture. Let’s look at what goes into an ICD-10-CM diagnosis for a fracture.

1. Specify the lateral side in each and every case
2. Document type of fracture.
   1. Open
   2. Closed
   3. Pathologic
   4. Stress/Fatigue
   5. Displaced or nondisplaced
3. Specify the location of the fracture.
   1. Head
   2. Shaft
   3. Distal
   4. Proximal
4. Document the pattern
   1. Transverse
   2. Oblique
   3. Segmental
5. Specify the encounter type.
   1. Initial (use seventh digit “A”)
   2. Subsequent (use seventh digit “D”)
   3. Sequela (use seventh digit “S”)
6. Document the status in the post-op period at time of subsequent encounters.
   1. Routine healing
   2. Delayed healing
   3. Nonunion
   4. Malunion

Example: Patient comes in for initial treatment of a hip stress fracture, where the pattern is transverse-posterior. The correct code is S32.461A (displaced associated transverse-posterior fracture of right acetabulum, initial encounter for closed fracture).

Open Fractures in ICD-10

There’s an extra level of detail with open fractures in ICD-10. There’s something called the Gustilo open fracture classification system, which categorizes open fractures into three types based on the cause of injury, extent of soft tissue damage, and amount of bone damage. The classes are I, II, and III, with class III further subdivided into A, B, or C.

The extensions available for these open fractures are:

• B, Initial encounter for open fracture type I or II
• C, Initial encounter for open fracture type IIIA, IIIB, or IIIC
• E, Subsequent encounter for open fracture type I or II with routine healing
• F, Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
• H, Subsequent encounter for open fracture type I or II with delayed healing
• J, Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
• M, Subsequent encounter for open fracture type I or II with nonunion
• N, Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
• Q, Subsequent encounter for open fracture type I or II with malunion
• R, Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion

Tip: If a fracture isn’t indicated as displaced or nondisplaced, you should default to coding it as displaced. You should default to closed if a fracture isn’t indicated as open or closed.

Providers are not coders, nor should we expect them to be. Therefore, it is crucial that you pay extra attention to the information they capture in their documentation. Requesting an addendum for clarity is always an option to ensure the documentation is correct, compliant, and fully supporting the billed services. 

Educating your physicians to include the pattern in addition to laterality and type continually will be a huge time-saver for a fracture. If your providers use a fracture care template, consider adding an inquiry for each component to ensure documentation is included for proper ICD-10 coding.

— John Burns, CPC, CPC-I, CEMC, CPMA. The originating author

— Shannon DeConda, CPC, CPC-I, CEMC, CPMA, CEMA. Content revision author