fracture coding cm and pcs
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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
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