Treating Fractures and Dislocations

“Spotlight on CPT” this month will focus on treatment of fractures/dislocations.  The CPT manual provides two areas of notes that can assist coding professionals when coding treatment of fractures or dislocations.  The first of these notes appears at the beginning of the Musculoskeletal System section of codes.  The other is found later in the section, just before the codes related to casts and strappings, which begins at 29000.

The first set of notes explains the difference between open and closed treatment.  Closed treatment means that the fracture did not require an incision for viewing or treatment.  Closed treatment occurs with or without manipulation or traction.  On the other hand, open treatment means that an incision occurs either at the fracture site or away from the fracture in order to visualize and treat.  Internal fixation or intramedullary nails or rods may be utilized to repair fractures in an open manner.   

Another type of treatment is percutaneous fixation, where imaging is used to visualize the fracture and then fixation is placed.  This differs from the other types of fixation: either internal (plates, rods, pins) or external (an external fixator with pins and device). 

Coding professionals need to recognize that the method of fracture repair (open, closed, or percutaneous) does not necessarily correlate with the type of fracture (open, closed).  For example, an closed Colles’ fracture of the left wrist may require an open reduction and internal fixation.
Manipulation is synonymous with reduction when discussing fractures and dislocations.  Either are attempts to restore proper alignment.  

Casts and strapping codes present challenges for coding professionals.  The first thing to remember is that if any restorative treatment is performed for the injury, the provider will code only for the restorative treatment (i.e. reduction, external fixation, etc.) rather than assign a cast/strap code. 
Casts or strapping should be coded when:

• It is a replacement procedure
• It is an initial service if no restorative treatment takes place 
• Provider only provides initial care (ER doctor)

If a provider performs both the initial cast and then follow up care, they must use a treatment code rather than a cast/strapping code since again these the first cast/strap/splint is included in the treatment code.

If we keep in mind that casts/strappings are considered part of fracture/dislocation care, it makes it easier to decide when to assign those codes. 
   
Now, light has been shed on coding fracture/dislocation treatment.

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.