ICD-10-CM and ICD-10-PCSFracture Coding

Char Gore, RHIA, CCSKim Lee, RHIA, CCS-P, CPC

Terminology Review

Abbreviations - General

• CC = chief complaint• DS = discharge summary• DX = diagnosis• H&P = history and physical• PE = physical exam• PMH = past medical history• ROS = review of systems

Abbreviations - Orthopedic

• FX = fracture• C1-C7 = cervical vertebrae• DIP = distal interphalangeal (joint)• L1-L5 = lumbar vertebrae• LLE = left lower extremity• LUE = left upper extremity• RLE = right lower extremity• RLU = right upper extremity

• ORIF = Open reduction and internal fixation• PIP = proximal interphalagenal (joint)• ROM = range of motion• S1 = first sacral vertebra• T1-T12 = thoracic vertebrae• THR = total hip replacement• Tib-fib = tibia-fibula

Your turn • FX• C1-C7• DIP• L1-L5• LUE• LLE• RLE• RUE

• ORIF• PIP• ROM• S1• T1-T12• THR• Tib-fib

• CC• DS• DX• H&P• PE• PMH• ROS

Directions

Anatomical Position

Posteroanterior

Let’s Play Simon Say’s

Anatomy Review

Bones

Can you do it?

FRACTURES

• Open• Closed• Colles• Comminuted• Compression• Depressed• Greenstick

• Hairline• Displaced• Nondisplaced• Oblique• Spiral• Transverse

Open Vs. Closed

OpenBone breaks through the overlying skin

ClosedBone does not break through the overlying skin

Colles

Distal radius FX

Comminuted

Bone crushed into several pieces

Compression

Vertebrae compressed together.

Could be traumatic (from a fall on the buttocks) or pathologic (due to disease where it collapses on itself)

Depressed

Inward fracture

Greenstick

Broken on only one side. Common in children

Hairline

Very thin – bone pieces still together

Displaced and Non displaced

Non displaced = normal alignment

Displaced = pulled out of normal alignment

Oblique

Broken in obliqueangle

Spiral

Due to a twisting force

Transverse

Broken in a transverse plane

Yep – Your turn now

Colles

Comminuted

Compression

Depressed

Greenstick

Hairline

Non displaced and Displaced

Oblique

Spiral

Transverse

Take a Break

ICD-10-CM Brief Overview

Taking what you know in 9 and applying it to 10

Snapshot of the systemsICD-9-CM• Numeric• 3 to 5 digits• 3 digits then a decimal• Covered Chapter 17

– 486 Pneumonia, NOS– 401.9 HTN, NOS– 034.0 Strep sore throat

ICD-10-CM• Alphanumeric• 3 to 7 characters• 3 characters then a decimal• Covered chapter 19

– J18.9 Pneumonia, NOS– I10 Essential HTN– J02.0 Strep pharyngitis

Official Coding Guidelines Conventions and General Guidelines are very similar – instructional notes, manifestation of disease coding, sequencing rules, etc.

Basically the same• Assign separate codes for each injury • Most serious injury sequenced first– Most serious FX sequenced first if multiple

• FX not indicated as open or closed = closed• Still required– External Cause– Place of occurrence– Activity– Status• We just don’t call these E-codes anymore – they are V-Y

New Guidelines

• FX not indicated as displaced or not displaced = displaced (displaced does not = open).

• FX code includes info to indicate which encounter this is– Aftercare is now included in the ICD-10-CM

diagnosis code (in I-9 we used a V code)– Late effects now called sequela. There is one

combination code that includes both the sequela and the original fracture.

Three Big Differences in Orthopedic diagnosis codes

Laterality• Right side / Left side

7th character

• Type of Fracture (open/closed)

• Initial Encounter / subsequent encounter

• Reason for subsequent encounter – Delayed healing – Nonunion, malunion

• Sequela (late effect)

Specificity

• Type of fractures– Greenstick– Transverse– Spiral– oblique

Laterality

ICD-9-CM

825.25 Fracture, Closed metatarsal bone(s)

No code for fifth metatarsal

ICD-10-CM

S92.352- Displaced fracture of fifth metatarsal bone, left foot

*also need 7th character to explain encounter

Fracture of the fifth metatarsal bone of the left foot

Specificity to Fracture Type

ICD-9-CM

813.21 Fracture, Shaft, Radius alone

No code for “greenstick fracture” – just codes to radial shaft

ICD-10-CM

S52.311- Greenstick Fracture of shaft of radius, right arm

*also requires a seventh character to denote encounter

Greenstick Fracture of the Right Radial Shaft

Possible 7th Characters

ICD-9-CM

• Fracture fifth metatarsal bone left foot– 825.25 Fracture, Closed

metatarsal bone(s)

• Greenstick Fracture Right Radial Shaft– 813.21 Fracture, Shaft, Radius

alone

ICD-10-CM

• Fracture fifth metatarsal bone left foot– S92.352A Displaced fracture

of fifth metatarsal bone, left foot, initial encounter

• Greenstick Fracture Right Radial Shaft– S52.311A Greenstick Fracture

of shaft of radius, right arm, initial encounter

Initial Encounters

Malunion

ICD-9-CM733.81 malunion fracture

905.4 Late effect of fracture of lower extremities

ICD-10-CMS72.321P Displaced Transverse fracture of the shaft of the right femur, subsequent encounter for fracture with malunion

Malunion of a previously displaced transverse fracture of the shaft of the right femur

Encoder Practice

Give me some to look up!

Getting to Know – ICD-10-PCS

• Totally different from ICD-9-CM• How?– Structure– Organization– Expandability

Other Important Features of ICD-10-PCS

• Standardized terminology• Specificity• No explicit “NOS” code options• Limited use of “NEC” code options

Format / Structure of ICD-10-PCS Codes

• 7 Characters• Any character can be alpha or numeric• Numerals 0 – 9 used• 24 letters used, A – H, J – N, and P – Z are used– Letters I and O are not used

• Decimals are not used• ICD-10-PCS Code

1 2 3 4 5 6 7

Valid Code Example Using ICD-10-PCS

• Open fracture reduction right tibia – 0QSG0ZZ

Let’s Play A Game!

Value Approach Definition Examples

0 Open Cutting through skin or mucous membrane and any other body layers necessary to expose the site of the procedure

CABGORIF

3 Percutaneous Entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach the site of the procedure

Needle biopsy of thyroid

4 Percutaneous Endoscopic Entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach the site AND visualize the site of the procedure

Arthroscopy

7 Via Natural or Artificial Opening Entry of instrumentation through a natural or artificial external opening to reach the site of the procedure

Foley catheter

8 Via Natural or Artificial Opening Endoscopic

Entry of instrumentation through a natural or artificial external opening to reach the site of the procedure AND visualize the site of the procedure

Colonoscopy

F Via Natural or Artificial Opening With Percutaneous Endoscopic Assistance

Entry of instrumentation through a natural or artificial external opening and entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to aid in the performance of the procedure

Laproscopic assisted vaginal hysterectomy

X External Procedures performed directly on the skin or mucous membrane and procedures performed indirectly by application of external force through the skin or mucous membrane

Closed reduction of fracture

Let’s Play Another Game!

Coding Fractures Using ICD-1-PCS

• Coding Guideline B3.15

Let’s Play Another GameCoding Scenarios

• Case 1• Case 2• Case 3

Resources

• ICD-10-CM Official Coding Guidelines FY11 http://www.cdc.gov/nchs/data/icd10/10cmguidelines2012.pdf

• ICD-9-CM Official Coding Guidelines FY11 http://www.cdc.gov/nchs/data/icd9/icdguide10.pdf

• Root Operations: Key to Procedure Coding in ICD-10-PCS, Anne Barta, MSA, RHIA & Ann Zeisset, RHIT, CCS, CCS-P

• Microsoft Clip Art