The Coding Corner

Q. We are hearing that there is more specificity required in ICD-10.  Can you explain how this will affect coding for fractures?

A. There is much more specificity required in ICD-10. The documentation for fractures will need to support:

• Open vs. closed
• Displaced vs. nondisplaced
• Name of bone and specific part of bone that is fractured
• Laterality – right or left
• Orientation of fractures (eg. transverse, oblique, spiral, comminuted and segmental for fractures of the shaft of the bone)
• Open fracture type using the Gustilo classification
• Growth plate fracture type using the Salter-Harris classification
• Sacral fracture type or zone
• Initial encounter, subsequent encounter or sequela (late effects)
• Traumatic fracture vs. pathologic fracture.  The ICD-10 guidelines state that a fracture is considered pathological if a patient with known osteoporosis suffers a fracture from a minor fall or trauma that would not usually break a healthy bone.
• Types of healing:  routine healing, delayed healing, nonunion, and malunion