Coding Injuries in ICD-10-CM -Part 2

Fracture coding:

The ICD-10-CM fracture codes offer greater specificity than ICD-9-CM. For example, ICD-10-CM fracture codes can indicate the type of fracture (eg, green, transverse, oblique, spiral, fragmented), the specific anatomical site, whether the fracture is displaced or not, laterality, pseudarthrosis, and slander. Laterality and type of encounter (initial, subsequent, sequelae) are significant components of code expansion.

To provide additional specificity, fracture extensions are expanded to include:

• A , initial encounter with closed fracture

• B, initial encounter for open fracture

• D, Subsequent Encounter for Fracture with Routine Healing

• G, Subsequent Encounter for Fracture with Delayed Healing

• K, Subsequent meeting for fracture with pseudarthrosis

• P, Subsequent Encounter for Fracture with Cal malice

• S, Sequela

Some categories of fractures provide seventh-character extensions for the specific type of open fracture. These designations are based on the Gustilo open fracture classification and apply to categories S52 (Forearm Fracture), S72 (Femur Fracture) and S82 (Lower Leg Fracture).Get More Info on Medical Coding Training

The Gustilo open fracture classification for extremities classifies open fractures into three main categories (types) based on lesion mechanism, soft tissue injury, and degree of skeletal involvement. The classes are I, II and III, with the third class subdivided into A, B or C.

The Gustilo classification is used to identify the severity of soft tissue injury. The rates of healing, infection, and amputation of fractures correlate with the degree of soft tissue injury by Gustilo and help determine the prognosis.

The available extensions for these open fractures are:

• B, initial encounter for open fracture type I or II

• C, initial encounter for type of open fracture IIIA, IIIB or IIIC

• E, subsequent encounter for open fracture type I or II with routine healing

• F, subsequent encounter with type IIIA, IIIB or IIIC open fracture with routine healing

• H, subsequent encounter for open fracture type I or II with delayed healing

• J, subsequent encounter with type IIIA, IIIB or IIIC open fracture with delayed healing

• M, subsequent encounter for open fracture type I or II with nonunion

• N, subsequent encounter with type IIIA, IIIB or IIIC open fracture with nonunion

• Q, subsequent encounter for type I or type II open fracture with malunion

• R, subsequent meeting for a type of open fracture IIIA, IIIB or IIIC with a malunion

In ICD-10-CM, a fracture not indicated as displaced or unmoved should be coded as displaced, and a fracture not designated as open or closed should be coded as closed.For more details: Medical Coding Training