April 3, 2012

Pathological Fracture Coding in ICD-10-CM

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A pathological or fragility fracture is defined as a fracture sustained due to trauma no more severe than a fall from standing height, with the break occurring under circumstances that would not cause a fracture in a normal, healthy bone.

In ICD-10-CM there is one code to indicate a personal history of a pathological fracture:

 

Z87.311 Personal history of (healed) other pathological fracture

There are four ICD-10-CM subcategories for coding of a new pathological fracture:

M80.0 Age-related osteoporosis with current pathological fracture
Includes: Involutional osteoporosis with current pathological fracture
Osteoporosis NOS with current pathological fracture
Postmenopausal osteoporosis with current pathological fracture
Senile osteoporosis with current pathological fracture
M80.8 Other osteoporosis with current pathological fracture
Includes: Drug-induced osteoporosis with current pathological fracture
Idiopathic osteoporosis with current pathological fracture
Osteoporosis of disuse with current pathological fracture
Postoophorectomy osteoporosis with current pathological fracture
Postsurgical malabsorption osteoporosis with current pathological fracture
Post-traumatic osteoporosis with current pathological fracture
M84.4 Pathological fracture, not elsewhere classified
Includes: Chronic fracture
Pathological fracture not otherwise specified (NOS)
M84.5 Pathological fracture in neoplastic disease
M84.6 Pathological fracture in other disease

ICD-10-CM Coding Tips:

  • The seventh character “A” is for use as long as the patient is receiving active treatment for a pathologic fracture. Examples of active treatment include surgical treatment, emergency department encounters and evaluation and treatment by a new physician. The seventh character “D” is to be used for encounters occurring after the patient has completed active treatment. The other seventh characters, listed under each subcategory in the tabular list, are to be used for subsequent encounters for treatment of problems associated with healing, such as malunions, nonunions and sequelae. Care for complications of surgical treatment of fracture repairs, occurring during the healing or recovery phase, should be coded with the appropriate complication codes.
  • When an encounter occurs for a pathological fracture due to a neoplasm and the focus of treatment is the fracture, a code from subcategory M84.5, Pathological fracture in neoplastic disease, should be sequenced first, followed by the code for the neoplasm.  If the focus of treatment is the neoplasm, with an associated pathological fracture, the neoplasm code should be sequenced first, followed by a code from M84.5 for the pathological fracture.
  • Category M80, Osteoporosis with current pathological fracture, is for patients who have a current pathologic fracture at the time of an encounter. The codes under M80 identify the site of the fracture. A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture – even if the patient had a minor fall or trauma – if that fall or trauma would not usually break a normal, healthy bone.

 


 

Sources:

Jones, Lolita M. (2012). Chapter 13: Diseases of the musculoskeletal system and connective tissue (M00 – M99), ICD-10-CM Core Concepts: A Chapter-by-Chapter Review of Coding Conventions and Challenges (pp. 13-28 thru 13-30). Fort Washington, Md.,: Lolita M. Jones Consulting Services.

 

National Center for Health Statistics (NCHS). ICD-10-CM Official Guidelines for Coding and Reporting, 2012, http://www.cdc.gov/nchs/data/icd10/10cmguidelines2012.pdf

 

EXERCISES:

In order to prepare you for ICD-10-CM coding of pathological fractures, the following exercise has been prepared as an educational tool.

A 2012 ICD-10-CM code book or an electronic file of the code book contents will be needed in order to use this coding manual. To access the 2012 ICD-10-CM code book electronic files, please go online to http://www.cms.gov/ICD10/11b14_2012_ICD10CM_and_GEMs.asp#TopOfPage .

Under the “Downloads” subheading, scroll down and download the folder titled “2012 Code Tables and Index [ZIP, 16.7MB] .” Once the folder is open, you will find several files, and you will need the following files when completing these exercises:

“ICD10CM_2012_Full_Tabular.pdf” – this is the 2012 ICD-10-CM Tabular List of Diseases and Injuries.

“ICD10CM_2012_Full_DIndex.pdf” –  this is the 2012 ICD-10-CM Index to Diseases and Injuries.

 

EXERCISE: Use the ICD-10-CM index of diseases and the tabular list to complete the following chart. One row has been completed as an example. Do not code from this chart; it is to be used for educational purposes only.

 

TYPE OF FRACTURE

FEMUR     RIGHT

FEMUR        LEFT

FEMUR BILATERAL

TIBIA         RIGHT

TIBIA           LEFT

TIBIA BILATERAL

Current pathological fracture with age-related osteoporosis

 

 

 

 

   

 

 

Current pathological fracture with other osteoporosis

 

 

 

 

   

 

 

Pathological fracture

 

 

 

 

   

 

 

Pathological fracture in neoplastic disease

M84.551- with neoplasm code

 

M84.552-with neoplasm code

M84.551-M84.552-

with neoplasm code

M84.561-

with neoplasm code

M84.562-

with neoplasm code

M84.561-M84.562-

with neoplasm code

Pathological fracture in other diseases

 

 

 

 

 

 

 

 



 

 

 

 

ANSWER KEY

 

TYPE OF FRACTURE

FEMUR     RIGHT

FEMUR        LEFT

FEMUR BILATERAL

TIBIA         RIGHT

TIBIA           LEFT

TIBIA BILATERAL

Current pathological fracture with age-related osteoporosis

M80.051-

M80.052-

M80.051-M80.052-

M80.061-

M80.062-

M80.061-M80.062-

Current pathological fracture with other osteoporosis

M80.851-

M80.852-

M80.851-M80.852-

M80.861-

M80.862-

M80.861-M80.862-

Pathological fracture

M84.451-

M84.452-

M84.451-M84.452-

M84.461-

M84.462-

M84.461-M84.462-

Pathological fracture in neoplastic disease

M84.551- with neoplasm code

 

M84.552-with neoplasm code

M84.551-M84.552-

with neoplasm code

M84.561-

with neoplasm code

M84.562-

with neoplasm code

M84.561-M84.562-

with neoplasm code

Pathological fracture in other diseases

M84.651-

with disease code

M84.652-

with disease code

M84.651-M84.652-

with disease code

M84.661-

with disease code

M84.662-

with disease code

M84.661-M84.662-

with disease code

 

 

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Lolita M. Jones, RHIA, CCS

Lolita M. Jones, RHIA, CCS, is the principal of Lolita M. Jones Consulting Services (LMJCS), founded in October 1998 in Fort Washington, MD. Ms. Jones has over 25 years of experience in coding and consulting. She started preparing for the implementation of ICD-10-CM/PCS by going back to school. On September 12, 2010, Ms. Jones became an AHIMA-approved ICD-10-CM/PCS trainer.