Pathologic fracture

katysuegood@gmail.comkatysuegood@gmail.com
in CDI Talk Archive
Hi All,
I am providing some education to CDI, coding, and MD's regarding pathologic fractures as we rarely get a connection documented between osteoporosis and fractures. I want to include implications for I-9 and I-10. When using the index in the I-10 book or the encoder, it basically looks the same to me. Start with Fracture and you will be prompted to classify is as traumatic, pathologic, osteoporotic, burst, fatigue, etc. Then add location and specificity etc. However I came across this article in ACP Hospitalist which suggests that if a patient has both osteoporosis and a low-impact trauma or no trauma it would be assumed to be osteoporotic. I am looking for some sort of reference to substantiate/negate this.

http://www.acphospitalist.org/archives/2014/05/coding_ICD-10.htm


Thanks!

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

Comments

  • fishdl@shands.ufl.edufishdl@shands.ufl.edu
    edited April 2016
    Coding Clinic 4Q 1993 discusses this issue and states, "Only the physician can make the determination that the fracture is out of proportion to the degree of trauma."
    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Monday, March 09, 2015 2:51 PM
    To: Fisher, Donna L.
    Subject: [cdi_talk] Pathologic fracture

    Hi All,
    I am providing some education to CDI, coding, and MD's regarding pathologic fractures as we rarely get a connection documented between osteoporosis and fractures. I want to include implications for I-9 and I-10. When using the index in the I-10 book or the encoder, it basically looks the same to me. Start with Fracture and you will be prompted to classify is as traumatic, pathologic, osteoporotic, burst, fatigue, etc. Then add location and specificity etc. However I came across this article in ACP Hospitalist which suggests that if a patient has both osteoporosis and a low-impact trauma or no trauma it would be assumed to be osteoporotic. I am looking for some sort of reference to substantiate/negate this.

    http://www.acphospitalist.org/archives/2014/05/coding_ICD-10.htm


    Thanks!

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404




  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    Yes, I am familiar with this one. That is referring to I-9. I am curious about changes in I-10. Dr. Pinson seems to me to be suggesting that this is changing but I don't see that in my draft code set or I-10 training software in 3M.

    Thanks!

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

  • sthomas7sthomas7
    edited April 2016
    A few times, I have been asked by the coders to query to link vertebral compression fractures to osteoporosis when a kyphoplasty was done. I don't have the references on this, but was told that medicare can deny coverage for the surgery if the compression fractures are not linked to osteoporosis. Not sure if that helps :)

  • annnd2009@gmail.comannnd2009@gmail.com
    edited April 2016
    I thought when surgery was done it did not matter financially as the kyphopladty takes a cc but a non -pathological fracture coded to medical back pain. So while not technically changing financial the pdx change allowing for a cc(if one on chart) would have financial impact...? Is that what you meant? Or your question is outpatient specific?

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    Hmmmm… that’s interesting. I haven’t heard that. These are our orthopods handling our hip fractures that are asking so not relevant to them, but still interesting.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited April 2016
    Perhaps check the Medicare Coverage Policy for kyphoplasty, as it may indicate that pathological fracture is one of the qualifying conditions for the procedure?

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

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  • axel.olson@essentiahealth.orgaxel.olson@essentiahealth.org
    if vertebral fracture is (pathologic) due to osteoporosis, curvature, malignancy, or infection and a fusion is done then the impact is very big.

    it will fall into the below DRGs which have a much larger RW

    456 Spinal Fus EXC CERV W SPINAL CURV/MALIG/INFEC OR 9+ FUS W/MCC
    457 W/CC
    458 W/O CC/MCC

    vertebral fx due to osteoporosis (733.13) as PDX meets criteria for the above DRG's

    typically, a patient that has a low fall and fractures a vertebrae (especially a burst fracture), has an underlying condition causing the easily fractured bone.

    Axel Olson RN, CCDS
    axel.olson@essentiahealth.org
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