ICD-10 Spotlight: Know the codes (7th character extension for episode of care for fractures)

May 31, 2012

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.