Fracture Diagnosis Prior To Coding Repair

By Author: Nancy Rose
Total Articles: 53
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Do not code a closed fracture treatment without more information.


Question: Our orthopedist tended to a patient in the emergency department for a gunshot wound and diagnosed a metacarpal fracture. He irrigated the site and eliminated a foreign body. Can we also go for a fracture code even though he did not manipulate the fracture?


Answer: If the documentation lists the fracture as a diagnosis (815.1x, Fracture of metacarpal bone[s]), you can report fracture care along with irrigation 20103 (Exploration of penetrating wound [separate procedure]; extremity).


If the notes document debridement, you might be able to report 11012 (Debridement including removal of foreign material associated with open fracture[s] and/or dislocation[s]; skin, subcutaneous tissue, muscle fascia, muscle, and bone) in place of 20103.


Keep a watch: When dealing with a contaminated wound, definitive fracture fixation would most probably be delayed until the immediate ...
... threat of infection passes. Owing to this, do not automatically submit a closed fracture treatment code unless you have more information to guide your choices. Go for a code for closed treatment without manipulation like 26600 (Closed treatment of metacarpal fracture, single; without manipulation, each bone) unless the fracture called for additional treatment while performing the open debridement.