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 [more than 24 hours] 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[1]

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 [2]

  • 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: [3]

  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. [4]

Related Topics

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

Medical Billing Expert Witness

Medical Bill Review

[1] [2] Nichols, J.  CD-10: Specified or Unspecified?

[3],[4] CMS.gov. Clinical Concepts for Orthopedics

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Michael F. Arrigo

Michael Arrigo, an expert witness, and healthcare executive, brings four decades of experience in the software, financial services, and healthcare industries. In 2000, Mr. Arrigo founded No World Borders, a healthcare data, regulations, and economics firm with clients in the pharmaceutical, medical device, hospital, surgical center, physician group, diagnostic imaging, genetic testing, health I.T., and health insurance markets. His expertise spans the federal health programs Medicare and Medicaid and private insurance. He advises Medicare Advantage Organizations that provide health insurance under Part C of the Medicare Act. Mr. Arrigo serves as an expert witness regarding medical coding and billing, fraud damages, and electronic health record software for the U.S. Department of Justice. He has valued well over $1 billion in medical billings in personal injury liens, malpractice, and insurance fraud cases. The U.S. Court of Appeals considered Mr. Arrigo's opinion regarding loss amounts, vacating, and remanding sentencing in a fraud case. Mr. Arrigo provides expertise in the Medicare Secondary Payer Act, Medicare LCDs, anti-trust litigation, medical intellectual property and trade secrets, HIPAA privacy, health care electronic claim data Standards, physician compensation, Anti-Kickback Statute, Stark law, the Affordable Care Act, False Claims Act, and the ARRA HITECH Act. Arrigo advises investors on merger and acquisition (M&A) diligence in the healthcare industry on transactions cumulatively valued at over $1 billion. Mr. Arrigo spent over ten years in Silicon Valley software firms in roles from Product Manager to CEO. He was product manager for a leading-edge database technology joint venture that became commercialized as Microsoft SQL Server, Vice President of Marketing for a software company when it grew from under $2 million in revenue to a $50 million acquisition by a company now merged into Cincom Systems, hired by private equity investors to serve as Vice President of Marketing for a secure email software company until its acquisition and multi $million investor exit by a company now merged into Axway Software S.A. (Euronext: AXW.PA), and CEO of one of the first cloud-based billing software companies, licensing its technology to Citrix Systems (NASDAQ: CTXS). Later, before entering the healthcare industry, he joined Fortune 500 company Fidelity National Financial (NYSE: FNF) as a Vice President, overseeing eCommerce solutions for the mortgage banking industry. While serving as a Vice President at Fortune 500 company First American Financial (NYSE: FAF), he oversaw eCommerce and regulatory compliance technology initiatives for the top ten mortgage banks and led the Sarbanes Oxley Act Section 302 internal controls I.T. audit for the company, supporting Section 404 of the Sarbanes Oxley Act. Mr. Arrigo earned his Bachelor of Science in Business Administration from the University of Southern California. Before that, he studied computer science, statistics, and economics at the University of California, Irvine. His post-graduate studies include biomedical ethics at Harvard Medical School, biomedical informatics at Stanford Medical School, blockchain and crypto-economics at the Massachusetts Institute of Technology, and training as a Certified Professional Medical Auditor (CPMA). Mr. Arrigo is qualified to serve as a director due to his experience in healthcare data, regulations, and economics, his leadership roles in software and financial services public companies, and his healthcare M&A diligence and public company regulatory experience. Mr. Arrigo is quoted in The Wall Street Journal, Fortune Magazine, Kaiser Health News, Consumer Affairs, National Public Radio (NPR), NBC News Houston, USA Today / Milwaukee Journal Sentinel, Medical Economics, Capitol ForumThe Daily Beast, the Lund Report, Inside Higher Ed, New England Psychologist, and other press and media outlets. He authored a peer-reviewed article regarding clinical documentation quality to support accurate medical coding, billing, and good patient care, published by Healthcare Financial Management Association (HFMA) and published in Healthcare I.T. News. Mr. Arrigo serves as a member of the board of directors of a publicly traded company in the healthcare and data analytics industry, where his duties include: member, audit committee; chair, compensation committee; member, special committee.