From the time ICD 10 codes have been implemented, coders are facing lot of issues with new diagnosis codes. Injury codes in ICD 10 are still creating problems for coders. For non-traumatic or pathological fractures, we have discussed previously. But for traumatic fracture coding, medical coders are still having lot of confusion. The initial, subsequent and sequela encounters of injuries codes have made coding little complicated. But, today I will try to clear your doubt in this article about coding fractures and the different types of fractures used in medical coding.

Traumatic fractures are coded using the appropriate 7th character for initial encounter (A, B, C) for each encounter where the patient is receiving active treatment for the fracture. The appropriate 7th character for initial encounter should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion.

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When to use Subsequent encounter codes

But, when should be the subsequent encounters be coded in injury coding. When the patient has completed active treatment of the fracture and is receiving routine care during the healing or recovery phase, subsequent encounters are coded using the appropriate 7th character for subsequent care of fractures. Also the care for complications of surgical treatment for fracture repairs during the healing or recovery phase should be coded with the appropriate complication codes. Care of complications of fractures, such as malunion and nonunion, should be reported with the appropriate 7th character for subsequent care with nonunion (K, M, N) or subsequent care with malunion (P, Q, R).

Difference between a Closed and Open Fracture

Medical coders are mostly confused with coding closed and open fracture or the fracture is traumatic or pathological. So, always remember a fracture not indicated as open or closed should be coded to “closed.” If you are not aware of Open and closed fracture definition, just read the below description.

Closed or simple fracture—In this type of fracture, the bone is broken, but the skin is not lacerated.

Open or compound fracture— In open fracture, the skin may be pierced by the bone or by a blow that breaks the skin at the time of the fracture. The bone may or may not be visible in the wound.

The step of the coder is to find out whether the fracture is displaced or nondisplaced along with the site of fracture. A fracture not indicated as “displaced” or “not displaced” should be coded to displaced. Also, do remember for fracture in upper or lower extremity should be coded with specific laterality (RT, LT, Bilateral) in ICD 10 coding. There are many different types of fracture you may come across while coding injury reports. Below is a list of common types of fracture in detail found in ICD 10 CM coding.

Burst: Compression of vertebral body due to a fracture

Comminuted: Fracture has broken bones into several small pieces

Depressed: Fracture is a piece of bone that is depressed, more common in the skull

Elevated: Fracture is a piece of bone that is elevated, more common in the skull

Fissure: Incomplete fracture of the outer portion of a bone that is nondisplaced

Greenstick: Incomplete fracture with bending of the bone, more common in children

Impacted: The ends of the fractured bone are pushed into each other

Linear: Fracture that runs parallel along the length of the bone

Missile: Open fracture caused by an outside force with a projectile

Puncture: Open fracture that perforates the skin

Salter-Harris (I-IV): Fractures through the growth plate of a bone in children

Spiral: Fracture due to a twisting force that results in a spiral break along the bone

Torus: Similar to a greenstick fracture with buckling on one side of the break

Wedge : Compression fracture that occurs in the lateral or anterior part of the thoracic spine

Complications during Healing phase of Fracture

Once the fracture is under the treatment phase or healing phase, there may be few complications with fracture. There are three common complication which you can see during the healing phase of fracture, delayed union, Nonunion and Malunion. Below is the exact definition of these complications.

Delayed union—a delay in normal fracture healing; not necessarily a pathological process

Nonunion—failure of healing of a fracture or osteotomy; with continued motion through a nonunion, a pseudarthrosis will form

Malunion—healing of a fracture in an unacceptable position