Basics about Fracture

Fracture is a break in bone or cartilage. Although usually a result of trauma, a fracture can be the result of an acquired disease of bone, such as osteoporosis. Most bone fractures are caused by falls and accidents. There are a number of different types of fractures, including avulsion, comminuted, and hairline fractures.

Fractures can be
• open or closed
• Simple or Compound

Common causes for fractures are
• Trauma
• Osteoporosis
• Overuse (stress fracture)
A cast, splint or strapping (29000-29750) may be applied to immoblize the fracture with or without a reduction of the fracture before casting.

Read also: Coding coding for Simple Repair CPT codes in ED

Difference between Closed and Open treatment

Closed treatment of fracture means that the fracture or disclocation site is not surgically opened or exposed to the external environment and directly visualized. Closed treatment fractures are treated with/without manipulation and with/without traction.
For example, closed treatment of acetabular fracture (27220-27222) may be done without manipulation (27220) with manipulation (27222) or with or without skeletal traction (27222)

27220 Closed treatment of acetabulum (hip socket) fracture(s); without manipulation
27222 with manipulation, with or without skeletal traction

Open treatment means the fractured bone is either surgically exposed to the external environment and the fracture is visualized to allow internal fixation or the fracture bone is opened remote from the fracture site in order to insert an intramedullary nail across the fracture site.

Debridement codes 11010-11012 are used for open fracture or open dislocation management.

CPT code 11010-11012 describe the debridement including the removal of foreign material at the site of an open fracture and/or an open dislocation for the skin and subcutaneous tissues, muscle fascia, muscle and bone. These codes report the often extensive wound excision and debridement necessary for open fractures and open dislocations, these codes should not be reported for closed fractures or closed dislocations.

11010 Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin and subcutaneous tissues

11011 ;skin, subcutaneous tissue, muscle fascia, and muscle
11012 ;skin, subcutaneous tissue, muscle fascia, muscle, and bone

CPT code 11010 is reported for debridement of skin and subcutaneous tissue; CPT code 11011 for debridement of skin, subcutaneous tissue, muscle fascia, and muscle; and CPT code 11012 for debridement of skin, subcutaneous tissue, muscle fascia, muscle, and bone.

When debridement is performed preparatory to the primary procedure (i.e., open fracture treatment), the debridement would not be reported separately as it is considered inherent to the primary procedure performed.

Percutaneous skeleton fixation is neither open nor closed and the fracture fragments are not visualized directly. Fins are inserted through the skin and into the bone fragments usually under x-ray imaging to secure the bones position. Kirscher wires (k wires) are commonly used for treatment of fractures. CPT code 20650, 20670, 20680 are few examples of percutaneous skeleton fixation.

20650 Insertion of wire or pin with application of skeletal traction, including removal (separate procedure)
20670 Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure)
20680 deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)

Internal fixation is the application of pins, nails or other hardware secured to the bone such as 20650, Insertion of wire or pin with application of skeletal traction, including removal (separate procedure)

External fixation involves the use of hardware (such as pins, wires, rods or rings) with as attaching device (external fixator) for treatment of fractures. For example, codes 20690-20697 relate to the application of an external fixation system. For application of external fixation in addition to internal fixation, report code 20690 and the appropriate internal fixation code.

If an external fixator is used intra-operatively solely as a fracture reduction aid (similar to a femoral distractor), it should not be reported separately, as it would be considered integral to the definitive procedure.

20690 Application of a uniplane (pins or wires in 1 plane), unilateral, external fixation system
20692 Application of a multiplane (pins or wires in more than 1 plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)
20693 Adjustment or revision of external fixation system requiring anesthesia (eg, new pin[s] or wire[s] and/or new ring[s] or bar[s])
20694 Removal, under anesthesia, of external fixation system
20696 Application of multiplane (pins or wires in more than 1 plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)
20697 exchange (ie, removal and replacement) of strut, each