Coding and Documenting Fractures in ICD-10

Coding and Documenting Fractures in ICD-10

  • 17 Oct Off
  • Share

by Christy Wills, CPC, CRC

Fracture coding has become increasingly more specific in ICD-10. As a result of this specificity, providers must document, in some form, whether the fracture is traumatic or pathologic (non-traumatic). A traumatic fracture is caused by some type of accident, fall, or other kind of force. For example, a traumatic fracture can occur after a car accident or when a person is struck with a heavy object. A pathologic, or non-traumatic fracture, is the break of a diseased or weakened bone (without noted trauma). This type of fracture can be caused by minor injury, or injury that would not, under normal circumstances, break healthy bone. Other pertinent information to include when documenting a fracture is the site; coders must note the site of the fracture. This includes not only which bone is broken, but also the specific location of the fracture on the bone. Coders must include details such as “distal end” or “proximal end”.

Christy Wills, CPC, CRC Coding Supervisor

Christy Wills, CPC, CRC
Coding Supervisor

In ICD-10 fractures caused by disease, not trauma, are classified as pathologic fractures. There are several diseases responsible for causing pathologic fractures, such as malignancy. However, it is important to note that not all pathologic fractures are due to malignancies. Other diseases responsible for causing pathologic fractures include: osteoporosis, osteomyelitis, and hyperparathyroidism. Unfortunately, most physicians do not document the fracture as pathologic (or traumatic), and as a result the lack of sufficient documentation leads to improper code selection and can be problematic for coders.

There is a separate section for Osteoporosis with a current pathologic fracture (M80- Series). A provider must remember to document the following details:

  • Whether the osteoporosis occurs with or without current pathologic fracture and history of pathologic fracture
  • The specific bone fractured and laterality, as appropriate
  • Whether the osteoporosis is age-related or due to some other specific cause (e.g., chronic steroid use or vitamin deficiency)

The final thing to remember when documenting fractures is indicating the episode of care. This is a significant change from ICD-9 and is necessary to complete the code. This seventh character in the code section and is as follows:

  • A: Initial encounter for fracture
  • D: Subsequent encounter for fracture with routine healing
  • G: Subsequent encounter for fracture with delayed healing
  • K: Subsequent encounter for fracture with nonunion
  • P: Subsequent encounter for fracture with malnutrition
  • S: Sequela
Share