What is a Pathological Fracture?
Fractures can be coded as traumatic or non-traumatic fractures. As we grow older, our bone density starts decreasing. Due to decrease in density, we may suffer from osteopenia or osteoporosis. Due to less bone density in old age, the bones get fractures even with a small injury. Sometimes even doing your day to day activity can lead to fracture, which is absolutely non-traumatic. Such fractures are called Pathological fracture. The bone diseases are harmful for older patients because bones are damaged or injured with slight trauma or injury. Now, here the question arises whether we should code a traumatic fracture or a Non-traumatic (pathological) fracture in such scenarios. So, let us learn more about this.
Pathological fracture is a bone fracture not due to trauma but due to an underlying disease process leaving the bone abnormal or weakened. The fracture may occur spontaneously or may be due to a minor trauma that would not normally cause a fracture.
Stress fracture describes a small crack or severe bruising within a bone. Overuse and repetitive activity such as running, sports, marching, and hiking can contribute to such an injury.
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How to confirm it is a Pathological fracture?
As I have said, diseases like osteoporosis can cause Pathological fracture. These fractures are spontaneous and occur in connection with minor injuries. Fractures generally occur when there is major or significant trauma. However, due to the weaking of bones the pathological fractures occur with even a slight trauma or injury. Hence, while coding a traumatic fracture, one should thoroughly check the medical record for any significant trauma. Generally, traumatic fractures occur because of any Motor vehicle accident, of a fall from high level, hit by a heavy object etc. But, if the patient comes with a fracture with minor injury and weak bones, the record should be coded with pathological fractures. Minor injuries cannot cause fractures in the healthy bones. I have come across many coding scenarios like to find an ICD 10 code for pathological fracture of vertebrae, femur, humerus or in neoplastic disease. Once you solve such medical reports of non-traumatic fractures, you wiill become perfect in the diagnosis coding of fractures.
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ICD 10 coding tips for Pathological Fractures
ICD-10-CM differentiates codes related to pathological fractures by the etiology:
- Pathological fractures in neoplastic disease (M84.5-)
- Pathological fractures in osteoporosis (M80.-)
- Pathological fractures in other disease (M84.6-)
- Pathological fractures, not elsewhere classified (M84.4-)
An Excludes1 note identifies traumatic fracture and stress fracture codes as an exclusion.
The diagnosis codes for non-traumatic fractures are very straightforward. The main difference will be the use of 7th character with these ICD 10 codes. The seventh character can be A, D or S mostly while code ICD 10 codes for pathological fractures.
7th character A for Initial Encounter, is used only when the patient is receiving active treatment for the fracture. It doesn’t matter whether he or she has multiple encounters or treated by different physician. The main principle to remember is whether he or she is still undergoing active treatment or not.
Now comes the 7th character D Subsequent Encounter, should be used only when the patient has completed his or her active treatment and again coming back for the treatment. Hence, all the encounters, which happened after completion of active treatment should be assigned as Subsequent, encounter (D). There are other lists of 7th characters present with problems associated with healing such as malunions, nonunions and sequela.
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ICD 10 codes for Osteoporosis with current pathological fracture
The ICD 10 category M80 should be used for coding Osteoporosis in combination with pathological fracture at the time of encounter. We have combine ICD 10 codes for both osteoporosis and current pathological fracture. It is very common in patients suffering from osteoporosis, usually get pathological fracture with minor injury. Hence, do use an ICD 10 code from M80 category to code a non-traumatic fracture when a patient is suffering from osteoporosis as well.