Each month, IBC will feature an example of how ICD-9 codes will translate to
ICD-10 codes. We will present coding examples from different specialties and
popular disease categories to demonstrate the granularity that the new ICD-10
code set will provide.
CODING CONVENTION: FRACTURES
The use of the ?seventh character extension? in ICD-10 codes is one example of
how the new code set will provide greater specificity and clinical detail.
Similar to injuries, poisonings, other consequences of external causes, and
conditions that affect a fetus (see the April edition of Partners in Health
Update for coding examples), the seventh character is designated to document
the episode of care for fractures as well. However, when documenting fractures,
the assignment of the seventh character is more complicated because it is
designated for additional information about the fracture, including whether the
fracture is open or closed and whether healing is routine or has complications
(i.e., delayed, nonunion, malunion).
The fracture seventh character extensions are:
A = Initial encounter for closed fracture
B = Initial encounter for open fracture
D = Subsequent encounter for fracture with routine healing
G = Subsequent encounter for fracture with delayed healing
K = Subsequent encounter for fracture with nonunion
P = Subsequent encounter for fracture with malunion
S = Sequela
Coding Example
Condition
Clinical documentation
ICD-10 code
Fracture of unspecified part of right clavicle, initial encounter for closed
fracture
S42.001A
Anterior displaced fracture of sternal end of right clavicle, initial encounter
for open fracture
S42.011B
Posterior displaced fracture of sternal end of right clavicle, subsequent
encounter
for fracture with routine healing
S42.014D
Nondisplaced fracture of sternal end of right clavicle, subsequent encounter for
fracture with delayed healing
S42.017G
3-part fracture of surgical neck of left humerus, subsequent encounter for
fracture with nonunion
S42.232K
Torus fracture of upper end of left humerus, subsequent encounter for fracture
with malunion
S42.272P
Fracture
Greenstick fracture of shaft of humerus, unspecified arm, sequela
S42.319S
In addition to the encounters above, there are seventh character extensions for
some types of open fractures that are grouped into the ?Gustilo Open Fracture
Classification.?
Open fractures (where bone pierces the skin) contain a much higher level of
specificity in ICD-10. Therefore, further classification is needed for open
fractures using the Gustilo Open Fracture Classification system. This
classification system groups open fractures into three main categories
designated as Type I, Type II, and Type III. Type III injuries are further
divided into Type IIIA, Type IIIB, and Type IIIC. The categories are defined by
three characteristics: mechanism of injury, extent of soft tissue damage, and
degree of bone injury or involvement.
The Gustilo classification groups are:
Type I ? Low energy, wound less than 1 cm
Type II ? Wound greater than 1 cm with moderate soft tissue damage
Type III ? High energy wound greater than 1 cm with extensive soft tissue damage
Type IIIA ? Adequate soft tissue cover
Type IIIB ? Inadequate soft tissue cover
Type IIIC ? Associated with arterial injury
Coding Example
Condition
Clinical documentation
ICD-10 code
Galeazzi?s fracture of left radius, initial encounter for open fracture Type
IIIA, IIIB,
or IIIC
S52.372C
Displaced comminuted fracture of shaft of ulna, left arm, initial encounter for
open fracture Type I or II
S52.252B
Monteggia?s fracture of left ulna, subsequent encounter for open fracture Type
I or II with routine healing
S52.272E
Open fracture
Bent bone of right ulna, subsequent encounter for open fracture Type IIIA, IIIB,
or IIIC with delayed healing
S52.281J
For additional information about IBC?s transition to ICD-10, please refer to
the
ICD-10 section of our
website.