Fracture Coding CM and PCS


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  • Because ICD-10-PCS has these three characteristics the codeset is able to be complete, flexible, and expandable. All ICD-10-PCS codes contain 7 characters that identify a category of specific information. ICD-10- PCS has a unique code that be assigned for every significant procedure. Each code retains its own unique definition. Codes are not reused in ICD-10-PCS.Expandability is also a characteristic of ICD-10-PCS. Unlike ICD-9 procedure codes that require whole codes to be added each year to account for the changes in technology and new procedures; ICD-10-PCS changes can be made within existing structure because whole codes are not added.
  • In ICD-9 you will find procedure codes that use terminology that includes eponyms, such as the name of a procedure named after a doctor, for example Collis Nissen, you will also see acronyms and other common terms such as CABG, or procedures that include the diagnosis in the code such as “wide excision of lesion on lip”. In ICD-10-PCS you will not find procedure names, diagnostic information, or eponyms. Instead each procedure is coded to the root operation that identifies the outcome of the procedure. The use of codes identified by “NOS and NEC” is not an option for “NOS” and limited for “NEC” that is because in ICD-10-PCS each character in the code defines information about the procedure and all 7 characters must contain a specific value from a single row of a table when you build a code. Let’s look at the format and structure of ICD-10-PCS codes.
  • The format and structure of ICD-10-PCS code consist of 7 characters, any character can be alpha or numeric, numerals 0 through 9 are used, 24 letters are used, letters I and O are no used so that coders do not become confused with 1 and 0. Decimals are not used. The ICD-10-PCS code is identified like this:1 = The section2 = The body system3 = The root operation4 = The body part5 = The approach6 = The device7 = The qualifierLet’s look at a valid code in ICD-10-PCS
  • As you can see on this slide the first three characters are identified by 0QS which is the section, body system, and operation. The last four characters identify the location of the fracture, right tibia, how the procedure was done, in this case it was open and the last two characters represent whether a device was used and other information about the procedure. You always have to have 7 characters in order for the code to be valid in ICD-10-PCS.
  • Great job everyone!
  • Now this is a jeopardy game so remember your answer must be in the form of “What is”!
  • Key words you should note “reposition, insertion, placement” These words will be helpful to know when looking up codes for procedures in ICD-10-PCS
  • Okay now we are going to take a look at some case scenarios. Feel free to work in groups!
  • Fracture Coding CM and PCS

    1. 1. ICD-10-CM and ICD-10-PCS Fracture Coding Char Gore, RHIA, CCS Kim Lee, RHIA, CCS-P, CPC
    2. 2. Terminology Review
    3. 3. Abbreviations - General• CC = chief complaint• DS = discharge summary• DX = diagnosis• H&P = history and physical• PE = physical exam• PMH = past medical history• ROS = review of systems
    4. 4. Abbreviations - Orthopedic• FX = fracture• C1-C7 = cervical vertebrae• DIP = distal interphalangeal (joint)• L1-L5 = lumbar vertebrae• LLE = left lower extremity• LUE = left upper extremity• RLE = right lower extremity• RLU = right upper extremity
    5. 5. • ORIF = Open reduction and internal fixation• PIP = proximal interphalagenal (joint)• ROM = range of motion• S1 = first sacral vertebra• T1-T12 = thoracic vertebrae• THR = total hip replacement• Tib-fib = tibia-fibula
    6. 6. Directions
    7. 7. Anatomical Position
    8. 8. Posteroanterior
    9. 9. Anatomy Review
    10. 10. FRACTURES• Open • Hairline• Closed • Displaced• Colles • Nondisplaced• Comminuted • Oblique• Compression • Spiral• Depressed • Transverse• Greenstick
    11. 11. Open Vs. Closed Open ClosedBone breaks through the Bone does not break throughoverlying skin the overlying skin
    12. 12. CollesDistal radius FX
    13. 13. Comminuted Bone crushed into several pieces
    14. 14. CompressionVertebrae Could becompressed traumatic (from atogether. fall on the buttocks) or pathologic (due to disease where it collapses on itself)
    15. 15. Depressed Inward fracture
    16. 16. GreenstickBroken on only one side.Common in children
    17. 17. Hairline Very thin – bone pieces still together
    18. 18. Displaced and Non displacedNon displaced =normal alignment Displaced = pulled out of normal alignment
    19. 19. ObliqueBroken in oblique angle
    20. 20. SpiralDue to a twisting force
    21. 21. TransverseBroken in atransverse plane
    22. 22. Colles
    23. 23. Comminuted
    24. 24. Compression
    25. 25. Depressed
    26. 26. Greenstick
    27. 27. Hairline
    28. 28. Non displaced and Displaced
    29. 29. Oblique
    30. 30. Spiral
    31. 31. Transverse
    32. 32. ICD-10-CM Brief Overview Taking what you know in 9 and applying it to 10
    33. 33. Snapshot of the systemsICD-9-CM ICD-10-CM• Numeric • Alphanumeric• 3 to 5 digits • 3 to 7 characters• 3 digits then a decimal • 3 characters then a decimal• Covered Chapter 17 • Covered chapter 19 – 486 Pneumonia, NOS – J18.9 Pneumonia, NOS – 401.9 HTN, NOS – I10 Essential HTN – 034.0 Strep sore throat – J02.0 Strep pharyngitis Official Coding Guidelines Conventions and General Guidelines are very similar – instructional notes, manifestation of disease coding, sequencing
    34. 34. Basically the same• Assign separate codes for each injury• Most serious injury sequenced first – Most serious FX sequenced first if multiple• FX not indicated as open or closed = closed• Still required – External Cause – Place of occurrence – Activity – Status • We just don’t call these E-codes anymore – they are V-Y
    35. 35. New Guidelines• FX not indicated as displaced or not displaced = displaced (displaced does not = open).• FX code includes info to indicate which encounter this is – Aftercare is now included in the ICD-10-CM diagnosis code (in I-9 we used a V code) – Late effects now called sequela. There is one combination code that includes both the sequela and the original fracture.
    36. 36. Three Big Differences in Orthopedic diagnosis codes Laterality 7th character • Right side / Left side • Type of Fracture (open/closed)Specificity • Initial Encounter / subsequent encounter • Type of fractures • Reason for subsequent – Greenstick encounter – Transverse – Delayed healing – Spiral – Nonunion, malunion – oblique • Sequela (late effect)
    37. 37. Laterality Fracture of the fifth metatarsal bone of the left footICD-9-CM ICD-10-CM825.25 Fracture, Closed S92.352- Displaced fracture ofmetatarsal bone(s) fifth metatarsal bone, left footNo code for fifth metatarsal *also need 7th character to explain encounter
    38. 38. Specificity to Fracture Type Greenstick Fracture of the Right Radial ShaftICD-9-CM ICD-10-CM813.21 Fracture, Shaft, Radius S52.311- Greenstick Fracturealone of shaft of radius, right arm *also requires a seventh character toNo code for “greenstick denote encounterfracture” – just codes to radialshaft
    39. 39. Possible 7th Characters
    40. 40. Initial EncountersICD-9-CM ICD-10-CM• Fracture fifth metatarsal • Fracture fifth metatarsal bone left foot bone left foot – 825.25 Fracture, Closed – S92.352A Displaced fracture metatarsal bone(s) of fifth metatarsal bone, left foot, initial encounter• Greenstick Fracture Right • Greenstick Fracture Right Radial Shaft Radial Shaft – S52.311A Greenstick Fracture – 813.21 Fracture, Shaft, Radius of shaft of radius, right alone arm, initial encounter
    41. 41. Malunion Malunion of a previously displaced transverse fracture of the shaft of the right femurICD-9-CM ICD-10-CM733.81 malunion fracture S72.321P Displaced Transverse fracture of the shaft of the905.4 Late effect of fracture of right femur, subsequentlower extremities encounter for fracture with malunion
    42. 42. Encoder PracticeGive me some to look up!
    43. 43. Getting to Know – ICD-10-PCS• Totally different from ICD-9-CM• How? – Structure – Organization – Expandability
    44. 44. Other Important Features of ICD-10- PCS• Standardized terminology• Specificity• No explicit “NOS” code options• Limited use of “NEC” code options
    45. 45. Format / Structure of ICD-10-PCS Codes• 7 Characters• Any character can be alpha or numeric• Numerals 0 – 9 used• 24 letters used, A – H, J – N, and P – Z are used – Letters I and O are not used• Decimals are not used• ICD-10-PCS Code 1 2 3 4 5 6 7
    46. 46. Valid Code Example Using ICD-10-PCS• Open fracture reduction right tibia – 0QSG0ZZ
    47. 47. Let’s Play A Game!
    48. 48. Value Approach Definition Examples0 Open Cutting through skin or mucous membrane and any CABG other body layers necessary to expose the site of ORIF the procedure3 Percutaneous Entry, by puncture or minor incision, of Needle biopsy of thyroid instrumentation through the skin or mucous membrane and any other body layers necessary to reach the site of the procedure4 Percutaneous Endoscopic Entry, by puncture or minor incision, of Arthroscopy instrumentation through the skin or mucous membrane and any other body layers necessary to reach the site AND visualize the site of the procedure7 Via Natural or Artificial Opening Entry of instrumentation through a natural or Foley catheter artificial external opening to reach the site of the procedure8 Via Natural or Artificial Opening Entry of instrumentation through a natural or Colonoscopy Endoscopic artificial external opening to reach the site of the procedure AND visualize the site of the procedureF Via Natural or Artificial Opening Entry of instrumentation through a natural or Laproscopic assisted vaginal With Percutaneous Endoscopic artificial external opening and entry, by puncture or hysterectomy Assistance minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to aid in the performance of the procedureX External Procedures performed directly on the skin or Closed reduction of fracture mucous membrane and procedures performed indirectly by application of external force through
    49. 49. Let’s Play Another Game!
    50. 50. Coding Fractures Using ICD-1-PCS• Coding Guideline B3.15
    51. 51. Let’s Play Another Game Coding Scenarios• Case 1• Case 2• Case 3
    52. 52. Resources• ICD-10-CM Official Coding Guidelines FY11 lines2012.pdf• ICD-9-CM Official Coding Guidelines FY11 pdf• Root Operations: Key to Procedure Coding in ICD- 10-PCS, Anne Barta, MSA, RHIA & Ann Zeisset, RHIT, CCS, CCS-P• Microsoft Clip Art