ICD-10 for Orthopedics – Fracture Concepts, Specificity, Laterality and Documentation

ICD-10 for Orthopaedics

ICD-10 for orthopedics includes the most number of codes, however, orthopedics concepts such as laterality (left, right) type of fracture, the severity of the fracture, issues such as how the fracture is healing are now spread across all bones of the human body.  Therefore while there are many more codes, there are a few key concepts that can help orthopedic specialists ensure that their documentation supports ICD-10.

Under ICD-10 CM diagnosis codes, there are 300 codes pertaining to fractures, such as the ankle, arm, elbow, femur, forearm, finger, foot, hand, head, hip, humerus, knee, leg, lower back, lumbar spine, neck, pelvis, rib, shoulder, skull/facial bones, thorax, thumb, toe, tooth, upper arm, vertebra, wrist.

It is not always true that ICD-10 requires more data and information (specificity) than ICD-9.

Not all ICD-10 Codes Require More Specificity than ICD-9.

For example, fractures of the skull coded in ICD-9 contain considerably more detail per code than similar codes in ICD-10.

ICD-9 Example:

  • 80024 (ICD-9) – Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged loss of consciousness and return to a pre-existing conscious level

ICD-10 Example:

  • S020XXA (ICD-10) – Fracture of vault of skull, initial encounter for closed fracture

Laterality and ICD-10

While it is generally believed that ICD-10 will require greater coding specificity, there are still many unspecified codes that providers could use within the selection of more specified codes.

Example: While ICD-10 provides the specificity of laterality, the coder could elect to not specify the side of the body for these orthopedic conditions 

  • S52101A – Unspecified fracture of upper end of right radius, initial encounter for closed fracture
  • S52102A – Unspecified fracture of upper end of left radius, initial encounter for closed fracture
  • S52109A – Unspecified fracture of upper end of unspecified radius, initial encounter for closed fracture

Fracture Documentation

When documenting fractures, include the following parameters:

  1. Type – e.g. Open, closed, pathological, neoplastic disease, stress e.g. Comminuted, oblique, segmental, spiral, transverse
  2. Pattern – e.g. Comminuted, oblique, segmental, spiral, transverse
  3. Etiology to document in the external cause codes – e.g. Normal healing, delayed healing, nonunion, malunion e.g. Shaft, head, neck, distal, proximal, styloid
  4. The encounter of care – e.g. Normal healing, delayed healing, nonunion, malunion e.g. Shaft, head, neck, distal, proximal, styloid
  5. Healing status, if subsequent encounter – e.g. Normal healing, delayed healing, nonunion, malunion
  6. Localization – e.g. Shaft, head, neck, distal, proximal, styloid
  7. Displacement – e.g. Displaced, non displaced
  8. Classification – e.g. Gustilo-Anderson, Salter-Harris
  9. Any complications, whether acute or delayed – e.g. Direct result of trauma sustained

In addition, depending on the circumstances, it may be necessary to document intra-articular or extra-articular involvement. For certain conditions, the bone may be affected at the proximal or distal end. Though the portion of the bone affected may be at the joint at either end, the site designation will be the bone, not the joint.

Related Topics

Analytics for ICD-10 May Only Work 65% of the Time – Or Not at All

Medical Billing Expert Witness

Medical Bill Review

Nichols, J.  CD-10: Specified or Unspecified?

, CMS.gov. Clinical Concepts for Orthopedics

Michael F. Arrigo

Michael is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. His vision for the firm is to continue acquisition of skills and technology that support the intersection of clinical data and administrative health data where the eligibility for medically necessary care is determined. He leads a team that provides litigation consulting as well as advisory regarding medical coding, medical billing, medical bill review and HIPAA Privacy and Security best practices for healthcare clients, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, physician compensation, Insurance bad faith, payor-provider disputes, ERISA plan-third-party administrator disputes, third-party liability, and the Medicare Secondary Payer Act (MSPA) MMSEA Section 111 reporting. He uses these skills in disputes regarding the valuation of pharmaceuticals and drug costs and in the review and audit of pain management and opioid prescribers under state Standards and the Controlled Substances Act. He consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises ERISA self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, studies at Harvard Medical School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims). Mr. Arrigo has been interviewed quoted in the Wall Street Journal, New York Times, and National Public Radio, Fortune, KNX 1070 Radio, Kaiser Health News, NBC Television News, The Capitol Forum and other media outlets. See https://www.noworldborders.com/news/ and https://www.noworldborders.com/clients/ for more about the company.

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