The Complete Diagnosis Coding Book by Shelley C The Complete Diagnosis Coding Book by Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA Chapter 8 Coding Orthopedics McGraw Hill/Irwin Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved

Learning Outcomes Distinguish between a fracture and a dislocation. 8 - 2 Learning Outcomes Distinguish between a fracture and a dislocation. Determine if a fracture is open or closed. Identify the appropriate segment of anatomical site involved.

8 - 3 Learning Outcomes Differentiate between pathological, spontaneous, and stress fractures. Apply the guidelines for coding late effects of fractures. Discern between an open and closed dislocation.

8 - 4 Introduction Conditions that affect the musculoskeletal system, such as a fracture or dislocation, can dramatically affect an individual’s quality of life.

Congenital Conditions 8 - 5 Congenital Conditions Musculoskeletal conditions that occur during gestation include: Clubfoot Hip dysplasia Muscular dystrophy These are coded not from this section but from the section on congenital anomalies.

Traumatic Fractures First Three Digits: Anatomical site 800–804 Skull 8 - 6 Traumatic Fractures First Three Digits: Anatomical site 800–804 Skull 805–809 Neck and Trunk 810–819 Upper limb 820–829 Lower limb

Traumatic Fractures Fourth Digit: Open or Closed 8 - 7 Traumatic Fractures Fourth Digit: Open or Closed Open: Broken bone protrudes through skin. Also called: Compound, Infected, Missile, Puncture, With Foreign Body

Traumatic Fractures Fourth Digit: Open or Closed 8 - 8 Traumatic Fractures Fourth Digit: Open or Closed Closed: Contained within the skin Also called: Comminuted, Depressed, Elevated, Fissured, Greenstick, Impacted, Linear, Simple, Slipped Epiphysis, or Spiral

Traumatic Fractures Fifth Digit: Segment of the Bone 8 - 9 Traumatic Fractures Fifth Digit: Segment of the Bone Terms include Condyle, Coronoid Process, Ramus, Symphysis, Intracranial, Cervical, Acetabulum, Shaft

8 - 10 Traumatic Fractures Traumatic fractures are injuries and therefore must be coded with E codes to report HOW the fracture happened. WHERE the patient was when he or she was injured.

Multiple Fractures Each fracture is coded separately. 8 - 11 Multiple Fractures Each fracture is coded separately. Report in order of severity—the most severe first. Report equally severe fractures in order from head to toe.

Late Effects of Fractures 8 - 12 Late Effects of Fractures NONUNION A fracture that has not healed back together. MALUNION A fracture that has not healed properly. Code either of these conditions as late effects of the original injury.

Pathological Fractures 8 - 13 Pathological Fractures When a fracture is caused by disease rather than injury it is called a Pathological Fracture or Spontaneous Fracture. E codes are not used with these fracture codes; however, there may be an underlying disease or condition that will have to be coded.

8 - 14 Stress Fractures A stress fracture, also known as a fatigue fracture, is often a sports injury. These are coded from a different area of ICD-9-CM: 733.93, 733.94, and 733.95.

8 - 15 Follow-Up Care During the healing process, the patient is typically seen several times. These should be coded from V54.xx.

Dislocations Open or Closed Specific anatomical site 8 - 16 Dislocations Dislocations and Subluxations are coded similarly to fractures: Anatomical region Open or Closed Specific anatomical site

Dislocations Fourth Digit: Open or Closed 8 - 17 Dislocations Fourth Digit: Open or Closed Open dislocation may be called compound. infected. with foreign body.

Dislocations Fourth Digit: Open or Closed 8 - 18 Dislocations Fourth Digit: Open or Closed Closed dislocation is also called complete. partial. simple. uncomplicated.

Pathological Dislocations 8 - 19 Pathological Dislocations When a dislocation is caused by disease rather than an injury, it is called a Pathological Dislocation or Spontaneous Dislocation. Report with 718.2 Pathological dislocation. E codes are not used with these fracture codes; however, there may be an underlying disease or condition that will have to be coded.

Sprains and Strains A sprain or strain may also be called a(an) 8 - 20 Sprains and Strains A sprain or strain may also be called a(an) avulsion, laceration, tear, hemarthrosis, or rupture and can occur in a joint capsule, ligament, muscle, or tendon.

Musculoskeletal Diseases 8 - 21 Musculoskeletal Diseases Bacterial inflammatory conditions Metabolic conditions Degenerative diseases Chronic diseases Skeletal deviations Muscular/Connective tissue conditions

8 - 22 Chapter Summary The musculoskeletal system can sustain injury in many different ways: fractures, dislocations, sprains, and strains. These conditions can be caused by trauma or disease.