Pathological Fracture Coding in ICD-10-CM

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

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.

ANSWER KEY