Q: Using the ICD-10-CM guidelines for the seventh character extensions for fracture codes, how should I identify each of the following?
- Avascular necrosis following fracture
- Cast change or removal
- Emergency treatment
- Evaluation and management by a new physician
- Follow-up visits following fracture treatment
- Infection on open fracture site
- Malunion of fracture
- Nonunion of fracture
- Medication adjustment
- Patient delayed seeking treatment for the fracture or nonunion
- Removal of external of internal fixation device
- Surgical treatment
A: Review the 2013ICD-10-CM Official Guidelines for Coding and Reporting, Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88).
The guidelines instruct coders to use the seventh character A, B, or C while the patient is receiving active treatment, including:
- Surgical treatment
- ED encounter
- Evaluation and treatment by a new physician.
The appropriate 7th character for initial encounter should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion.
Coders should assign the appropriate seventh charcater for subsequent care for encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase. Examples of fracture aftercare are:
- Cast change or removal
- Removal of external or internal fixation device
- Medication adjustment
- Follow-up visits following fracture treatment
Use the appropriate seventh character for subsequent care with nonunion (K, M, N,) or subsequent care with malunion (P, Q, R) to report care of complications of fractures..
Therefore, report the following:
- Sequela: Avascular necrosis following fracture
- Subsequent encounter: Cast change or removal
- Initial encounter: Emergency treatment
- Initial encounter: Evaluation and management by a new physician
- Subsequent encounter: Follow-up visits following fracture treatment
- Sequela: Infection on open fracture site
- Subsequent encounter: Malunion of fracture
- Subsequent encounter: Nonunion of fracture
- Subsequent encounter: Medication adjustment
- Initial encounter: Patient delayed seeking treatment for the fracture or nonunion
- Subsequent encounter: Removal of external or internal fixation device
- Initial encounter: Surgical treatment
Editor’s note: This Q&A was excerpted from HCPro’sICD-10 Competency Assessment for Coders.
