ICD-10 Coding Tips

Beginners Guide To Coding Fractures Using ICD-10-CM-Part 2

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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ICD-10 Coding Tips

Beginners Guide To Coding Fractures Using ICD-10-CM- Part 1

I have to admit, I was a little disturbed this week after reading through comments on a Facebook post. The post was about the different 7th characters and what they mean and when to add them. This is something that can be confusing for sure. The question was fine–it was the answers that scared me a little. I realized after reading that post, that many coders (not even new coders–I’m talking about experienced coders–do not understand seventh character A.

If you have your ICD-10-CM book around, please look in the beginning section of Chapter 19. Or just to make it easier–here is a pic from my book:

 

 

Please see what I’ve underlined above. “The 7th character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time.” The key is active treatment. That is what the A means. It has nothing to do with the provider seeing the patient. For example, if someone goes to the ER and it turns out he/she has a broken wrist–that encounter will be coded with 7th character A. Say this same person now follows up with their regular doctor the following day–the fracture is still coded with an A. It doesn’t change based on the provider or anything like that. It has to do with whether or not the patient is receiving active treatment. This patient is still receiving active treatment, so it’s still coded with seventh character A.

I can write many more posts about fracture coding (and I will if that’s something you guys are interested in) but I felt like I had to post about this. It is all here in the guidelines.

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Questions? Please feel free to comment below or email me at midnightmedicalcoding@gmail.com.

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