Ok, as a follow up to last weeks post about 7th character A, for this week I thought I’d talk about 7th character D and more just about fracture coding in general. Here is a pic from my book:
Please see the pic where I have the star. It says 7th character D is used for encounters after the patient has completed active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. Ok, just like I mentioned in the last blog post, the 7th character is not determined by provider or how many visits the patient has had, or anything like that. It just has to do with if the patient is in the healing/recovery phase or not. Examples of the recovery phase: if the patient is having x-rays to determine how a fracture is healing= 7th character D. Sometimes keywords in the report help as well. A radiologist will never say “patient is now in recovery/healing phase.” Keywords for healing is if the documentation mentions “callus formation.” Callus formation means the bones are healing.
Just in general, here are some more facts about fracture coding. These are all found in the ICD-10-CM Book in the guidelines about fracture coding. All fractures default to a displaced fracture if it is not documented as displaced or nondisplaced. (Displaced basically just means the bones are not lined up right). If the report specifies ‘nondisplaced’ fracture, then code it as nondisplaced.
All fractures default to a “closed” fracture if it’s not documented. Closed fracture means that there’s a broken bone but it is not coming out through the skin. This is really gross to think about but since we’re coders, we have to. Basically, if the report states “open fracture,” you’d code it as open fracture. But what that means is that the bone is so broken and messed up that you’d be able to see it. It’s through the skin (these are very bad fractures, sometimes from gunshot wounds and those types of injuries). Don’t worry–I will never post any real pics of fractures or anything on this site. Even though I can read reports for work, I can not look at real pictures or video of anything medical without completely losing it and feeling sick. Not sure if everyone is like that, but I’m the worst. It’s amazing I can even work as a coder I’m so bad with it.
Here are some different types of fractures, but these are drawings so I can handle it 🙂
Do you have any questions about fracture coding? Please comment below or email me at midnightmedicalcoding@gmail.com.
Thanks for reading-
Lindsay
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I code for a hospital, mainly surgeries and observations. On the surgical side, the fracture is in active status since say for a open reduction of the fracture repair with screws, plating and other devices to keep the fracture in place is done. But I do see some subsequent fractures on the observation side where the patient is in the hospital and is being treated now say for congestive heart failure or a stroke, but they have a subsequent fracture that was treated a month or so ago and is healing nicely and the physicians wont do any treatment towards that fracture, all the treatment is going for the more pressing diseases or symptoms now, the CHF or the stroke. Subsequent is monitoring- radilology, physical therapy, supervision, while active is surgical, emergency room, primary care physician and the services are actively treating, reducing, manipulating or correcting the fracture in the OR…
Yes, absolutely. Fractures on the surgical side are definitely in active status. The situation you mentioned about subsequent fractures on the observation side could happen also. With radiology though, it could go either way. Sometimes it’s active treatment sometimes it’s subsequent. It doesn’t always code to subsequent just because it’s an x-ray. For example–if you’re coding an x-ray for the radiologist in the ER–active. The next day the pt follows up with a primary care dr. The patient gets sent to an imaging center for an x-ray–it’s still active. It doesn’t change to subsequent based on who is seeing the patient. It depends where they are treatment-wise.