Coding for Fractures
More than one third of adults aged 65 and older fall each year in the United States. Among older adults, falls are the leading cause of injury deaths and the most common cause of nonfatal injuries and hospital admissions for trauma. The rates of fall-related deaths among older adults rose significantly over the past decade.
ICD-9-CM Coding for Traumatic Fractures
An open fracture has an open wound associated with the fracture. The following terms describe an open fracture: compound, infected, missile, puncture, and with foreign body.
ICD-9-CM Coding for Nontraumatic Fractures
Underlying causes of pathological fractures include osteoporosis, metastatic bone tumor, osteomyelitis, Paget’s disease, disuse atrophy, hyperparathyroidism, and nutritional or congenital disorders. However, the fact that the patient has a bone-weakening condition does not mean the fracture is pathologic. Only the physician can determine whether the fracture is considered traumatic or pathologic, and physician documentation must be obtained to clarify the diagnosis.
The following terms are synonymous with pathological fracture: insufficiency fracture, spontaneous fracture, nontraumatic fracture, and nontraumatic compression fracture.
When one of these terms is documented in the medical record, code 733.1x with the appropriate fifth digit may be assigned instead of a code from 800 to 829. If the physician documents stress fracture, assign one of the following codes:
• 733.93, Stress fracture of tibia or fibula;
• 733.94, Stress fracture of the metatarsals;
• 733.95, Stress fracture of other bone;
• 733.96, Stress fracture of femoral neck;
• 733.97, Stress fracture of shaft of femur; and
• 733.98, Stress fracture of pelvis.
• Vertebroplasty (81.65) is performed on patients for the treatment of vertebral compression fractures. It involves injecting a semiliquid material (polymethyl methylacrylate or methyl methacrylate) into the vertebral body. The material hardens and, in turn, stabilizes and strengthens the compression fracture. This procedure helps decrease pain and increase mobility in patients with osteoporosis (AHA Coding Clinic for ICD-9-CM, 1999, fourth quarter, page 22).
• Kyphoplasty (81.66) is a technique that combines vertebroplasty with the insertion of an inflatable bone tamp that restores the vertebral body height while creating a cavity to be filled with bone cement.
Coding and sequencing for fractures are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to nearly 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.