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ICD- 10 - CM Injury Coding for Orthopedics
Injuries in Orthopedics
Jaci Johnson CPC CPCH CPMA CEMC CPCI President Elect AAPC National Advisory Board 2013 - 2015 ICD- 10 - CM Injury Coding for Orthopedics
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2 ICD- 10 - CM Injury Coding for Orthopedics
- Traumatic fractures
- Dislocations
- Connective tissue and muscle injuries
AGENDA
ICD- 10 - CM Injury Coding for Orthopedics
- Type of fracture
- Closed
- Open
- Gustilo classification for open fractures
- Stage of healing
- Complications
Traumatic Fractures
ICD- 10 - CM Injury Coding for Orthopedics Shoulder injuries S42.151A Displaced fracture of neck of scapula, right shoulder, initial encounter for closed fracture S43.151A Posterior dislocation of right acromioclavicular joint, initial encounter Hip injuries S72.25XA Displaced subtrochanteric fracture of right femur, initial encounter for closed fracture S73.121A Ischiocapsular (ligament) sprain of right hip, initial encounter
Traumatic Fractures
ICD- 10 - CM Injury Coding for Orthopedics
- Fractures of specified sites are coded individually by site in accordance with the provisions of categories S02, S12, S22, S32, S42, S52, S 62, S72, S82, S and the level of detail in the medical record.
Principle of Injury coding
ICD- 10 - CM Injury Coding for Orthopedics
- Flat - strong, flat plates of bone with the main function of providing protection to the bodies’ vital organs and being a base for muscular attachment. Examples include the scapula and cranium.
- Irregular - bones which do not fall into any other category, due to their non-uniform shape. Examples include the vertebrae and sacrum.
- Sesamoid - usually short or irregular bones, imbedded in a tendon. Examples include the patella and pisiform (smallest of the Carpals).
Types of Bones
ICD- 10 - CM Injury Coding for Orthopedics
- Diaphysis - shaft of a long bone
- Epiphysis - end of the shaft of a long bone
- Metaphysis - growth plate region of a bone
Localization
ICD- 10 - CM Injury Coding for Orthopedics
- Condyle - rounded projection on the end of a bone and is usually found at the point of articulation
- Intercondylar - is located between two condyles The Lateral and medial epicondyles are is a rounded projection of the bone prior to the condyle which serves as a place of attachment of ligaments.
- Lateral Epicondyle - located on the lateral side of the bone
- Medial Epicondyle – located on the medial side of the bone
Localization
ICD- 10 - CM Injury Coding for Orthopedics
- Malunion - a faulty union of the fragments of the fractures bone
- Nonunion - the failure of the ends of the fractured bone to unite.
Localization
ICD- 10 - CM Injury Coding for Orthopedics Bobby injured his arm during a fall from a tree. After an examination and review of films he is diagnosed with an extraarticular fracture of the left distal radius. S52.552A Other extraarticular fracture of the lower end of left radius, initial encounter for closed fracture W14.XXXA Fall from tree, initial encounter
Example
ICD- 10 - CM Injury Coding for Orthopedics
- Greenstick - incomplete fracture in which the bone is fractured on one side and bent on the other. This type occurs most often in children.
- Bent Bone - a fracture where the bone is bent, creating multiple tiny fractures along the bone. This type of fracture is difficult to diagnosis as the fractures do not show up on x-rays.
Fracture Type
ICD- 10 - CM Injury Coding for Orthopedics
- Transverse - a fracture at a right angle to the bone’s axis. Usually, transverse fractures occur from some sort of direct blow or heavy repetitive action like running.
- Compound - , also known as an open fracture, is a fracture in which broken bone fragments lacerate soft tissue and protrude through an open wound in the skin.
- Monteggia’s - is a proximal one third fracture of the ulna with an associated dislocation of the head of the radius.
Fracture Types - continued
ICD- 10 - CM Injury Coding for Orthopedics
- Galeazzi’s - (pronounced gah-lā-ahtʹ-sē) fracture is a fracture of the radius shaft with an associated subluxation or dislocation of the distal ulna.
- Torus - a partial fracture where the bone is broken on one side and buckles outward on the other side.
- Oblique - a fracture which runs diagonally along the axis of a bone.
- Colle’s - a fracture of the distal end of radius within one inch of the joint.
Fracture Types - continued
ICD- 10 - CM Injury Coding for Orthopedics Patient suffered an extra-articular fracture of the right distal radius that occurred as the result of a fall onto an outstretched hand. X-ray showed a fracture of the distal radial metaphyseal region with dorsal angulation and impaction but without involvement of the articular surface with evidence of malunion. S52.531P Colles’ fracture of right radius, subsequent encounter for closed fracture with malunion
Example
ICD- 10 - CM Injury Coding for Orthopedics
- Smith’s - a fracture of the distal end of the radius. The proximal end of the radial fracture is displaced towards the back (dorsal) of the wrist.
- Barton’s - an intra-articular fracture of the distal radius with an associated dislocation of the radiocarpal joint.
Fracture Types- continued
ICD- 10 - CM Injury Coding for Orthopedics
- Bimalleolar - (pronounced bī–mal-ē-ō-lar) fracture is a fracture of both the lateral malleolus and the medial malleolus of the ankle.
- Trimalleolar - (pronounced tri-mal-ē-ō-lar) fracture is a fracture of the lateral malleolus, medial malleolus and the posterior malleolus.
- Maisonneuve’s - (pronounced MAY-ZO-euv) fracture is a spiral fracture of the proximal fibula with an associated tear of the distal tibiofibular syndesmosis and interosseous membrane. Fracture Types- continued ICD- 10 - CM Injury Coding for Orthopedics
- Pilon - a comminuted fracture of the tibia near the ankle. Many times there is an associated fracture of the fibula. This type of fracture is caused by high-energy vertical axial loading which may occur due to a fall from height or motor vehicle accident.
- Burst - a fracture of the vertebra caused by a high-energy axial load. This type of fracture is traumatic and may be the result of auto accidents, or falls from height or high speed.
- Compression- A vertebral compression fracture is a fracture that occurs when the bones of the spine become broken due to trauma.
Fracture Types- continued
ICD- 10 - CM Injury Coding for Orthopedics
- Classified by Gustilo classification
- Dependent
- Mechanism of injury
- Soft tissue damage
- Degree of skeletal involvement
- Three major categories
Open Fractures
ICD- 10 - CM Injury Coding for Orthopedics Type I
- The wound is less than 1 cm with minimal soft tissue injury, wound bed is clean
- The fracture is usually a simple transverse, short oblique fracture, or with minimal comminution. Type II
- The wound is greater than 1 cm with moderate soft tissue injury
- The fracture is usually a simple transverse, short oblique fracture, or with minimal comminution.
Gustilo Classifications
ICD- 10 - CM Injury Coding for Orthopedics Type III Type IIIA
- Adequate soft tissue coverage despite soft tissue laceration or high energy trauma irrespective of size of wound, and includes segmental or- severely comminuted fractures. Type IIIB
- Extensive soft tissue loss with periosteal stripping and bony exposure usually associated with massive contamination.
Type IIIC
- Major arterial injury repair is required for limb salvation.
Gustilo Classifications
ICD- 10 - CM Injury Coding for Orthopedics Patient is seen in emergency department following a motor vehicle accident. Patient was attempting to exit his car when it was struck by another car. He was not fully out of the vehicle, and the resulting impact caused the door to slam shut on his right forearm where it was wedged until assistance arrived. Assessment: Displaced transverse fracture of right ulna. Open fracture of radius with extensive comminution of the distal shaft fracture. There is also injury due to bone fragments of abductor pollicis longus muscle and possible the laceration of the extender carpi radialis brevis tendon.
Example
ICD- 10 - CM Injury Coding for Orthopedics S52.351C Displaced comminuted fracture of the shaft of radius, right arm, initial encounter for open fracture type IIIA S52.221C Displaced transverse fracture of shaft of right ulna, initial encounter for open fracture type IIIA V43.42XA Person boarding or alighting a car injured in collision with other type car
Example
ICD- 10 - CM Injury Coding for Orthopedics A initial encounter for closed fracture B initial encounter for open fracture type I or II or initial encounter for open fracture NOS C initial encounter for open fracture type IIIA, IIIB, or IIIC CODERS TIP
- Remember, the seventh character must always be the seventh character in the data field. If a code that requires a seventh character is not six characters in length, a placeholder X must be used to fill in the empty characters.
Initial Encounters
ICD- 10 - CM Injury Coding for Orthopedics
- Subsequent encounters with complications:
- Nonunion
- K Subsequent encounter for closed fracture with nonunion
- M Subsequent encounter for open fracture type I or II with nonunion
- N Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
Subsequent Encounters
ICD- 10 - CM Injury Coding for Orthopedics
- Subsequent encounters with complications:
- Malunion
- P Subsequent encounter for closed fracture with malunion
- Q Subsequent encounter for open fracture type I or II with malunion
- R Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
Subsequent Encounters
ICD- 10 - CM Injury Coding for Orthopedics A patient presents for a recheck of her closed fracture of the neck of the left radius. X-rays are taken and show a malunion of the fracture S52.132P Displaced fracture of neck of left radius, subsequent encounter for closed fracture with malunion
Example
ICD- 10 - CM Injury Coding for Orthopedics Mr. Johnson presents with complaints of left hip pain. He is six months post total replacement of same. He states that the pain is constant and if he sleeps on his left side he is woken at night by a stabbing pain at the upper end of his thigh. After examining the area and reviewing films, the orthopedist diagnosis the condition as pain due to prosthetic hip. T84.84XD Pain due to internal orthopedic prosthetic devices, implants and grafts
Example
ICD- 10 - CM Injury Coding for Orthopedics
- Encounters for sequela:
- Complications or conditions that arise as a direct result of an injury
- Code first the residual condition followed by the code to identify the condition responsible for the sequela
Late Effects
ICD- 10 - CM Injury Coding for Orthopedics William presents to the office with increasing right shoulder joint pain and a decrease in the previous range of motion for the same. He was seen in this office six months ago for a comminuted fracture of the right proximal humeral shaft which subsequently healed nicely. X-rays now show necrosis of the humeral head. M87.221 Osteonecrosis due to previous trauma, right humerus S42.351S Displaced comminuted fracture of shaft of humerus, right arm, sequela
Example
ICD- 10 - CM Injury Coding for Orthopedics
- The position of a dislocation refers to the position of a bone compared to its correct anatomic location.
- Position
- Anterior
- Posterior
- Inferior
- Laterally
Traumatic Dislocations
ICD- 10 - CM Injury Coding for Orthopedics 10 year-old Sara jumped from her swing while she was swinging on a swing set. She states she landed on her feet but fell forward and landed on her outstretched left arm. When she stood up she had pain at her shoulder and was unable to lift her arm. Plain films were completed. Assessment: Anterior partial dislocation of right humerus S43.011A Anterior Subluxation of right humerus, initial encounter
Example
ICD- 10 - CM Injury Coding for Orthopedics
- Not a combination code in ICD- 10 - CM
- Two codes are needed to identify the injury
- Dislocation or subluxation
- Associated open wound Instructional note at the beginning of each dislocation category directs coder
Open Dislocations
ICD- 10 - CM Injury Coding for Orthopedics Jessie was knocked down while feeding her pigs on the farm. She attempted to catch herself on her outstretched left forearm resulting in an open anterior dislocation of the left humerus. ICD- 9 - CM
- 831.11 Anterior dislocation of humerus, open ICD- 10 - CM
- S43.015A Anterior dislocation of left humerus, initial encounter
- S41.042A Puncture wound with foreign body of left shoulder, initial encounter
Example
ICD- 10 - CM Injury Coding for Orthopedics Connective tissues within the musculoskeletal system work with the muscles and bones to aide in the production of movement, dictate your degree of flexibility, and protect surrounding tissue during muscle movement Anatomy
- Fascia - a thin membrane surrounding the muscles, tendons, bones and other organs and tissues.
Connective Tissue & Muscle Injuries
ICD- 10 - CM Injury Coding for Orthopedics Anatomy
- Cartilage - a tough flexible tissue found in many places throughout the body. In relation to orthopaedics, cartilage cover and protect the end of the bone at the joint and allows the bones to articulate smoothly.
- Tendons - strong cords that attach muscle to bone at the point of insertion.
- Ligaments - like tendons are tough cords that connect bone to bone. Ligaments provide stability to joints by holding the end of bones in place at the joint.
Connective Tissue & Muscle Injuries
ICD- 10 - CM Injury Coding for Orthopedics
- Fasciitis
- Strains
- Sprains
Connective Tissue & Muscle Injuries
ICD- 10 - CM Injury Coding for Orthopedics While playing soccer at school, Keegan attempted to retrieve the ball and collided with an opposing team player. Upon attempting to stand he states he immediately felt pain upon standing and ambulating. MRI was reviewed and demonstrated a partial PCL tear of the right knee. S83.521A Sprain of the posterior cruciate ligament of the right knee, initial encounter W51.XXXA Accidental striking against or bumping into by another person, initial encounter Y93.66 Activity, soccer
Example
ICD- 10 - CM Injury Coding for Orthopedics
SFO
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