pathological fracture

Unknown

Good morning. I am trying to find the "official definitions of pathological and fragility fractures" from CMS for one of my orthopedic surgeons. Any suggestions as where to look? I have been unable to find anything specific. Thanks for any help!
Elaine Sakala RN/CDS/UR

ssalinas

I don’t know that CMS has a definition for pathological fracture. However the following is from CC 4th Qtr 1993. Basically it is up to the physician to make the determination if the fx is out of proportion to the degree of trauma.

Hope this helps -


Pathologic Fractures
A pathologic fracture is defined as a break in a diseased bone due to weakening of the bone structure by pathologic processes (such as osteoporosis or bone tumors) without any identifiable trauma or following only minor trauma. Only the physician can make the determination that the fracture is out of proportion to the degree of trauma. X-ray indications of diseased bone may be used by the physician to arrive at a diagnosis of a pathologic fracture, but should not be used by coders to make this determination.

Fifth digits have been added to category 733.1, Pathologic fracture, to allow identification of the site of the fracture. Codes from 800-829 for traumatic fractures should never be used with a code from this category. External cause of injury codes (E-codes) may be used if the pathologic fracture follows minor trauma to identify the nature of this trauma. The new codes are as follows:

Question:

After walking out of a nursing home and falling off the curb, an 89 year old woman, with a history of severe osteoporosis, is admitted to the hospital for a fractured left hip. X-rays show advanced osteoporosis, separation of the acetabulum, and crumbling fracture of head of the left femur. Should the fracture be coded as pathological or as the result of trauma?

Answer:
This is a clinical question that must be directed to the patient's physician. Sometimes minor trauma can cause a fracture in an individual with severely diseased bone, and that is called a pathological fracture. Only the physician can determine whether or not the level of injury is in accordance with the degree of trauma suffered by the patient.

If the physician determines that the fracture is due to trauma then only a code(s) from 800-829, Fractures, would be assigned. A code from category 733.0, Osteoporosis, may also be assigned. The pathological fracture code would not be assigned.

If, however, the physician determines that the fracture is pathological and due to osteoporosis, then code 733.14, Pathological fracture of neck of femur, and a code from category 733.0, Osteoporosis, should both be assigned. Code E888, Other and unspecified fall, may also be assigned.

Sharon Salinas, CCS
Health Information Management
Barlow Respiratory Hospital
2000 Stadium Way, Los Angeles CA 90026
Tel: 213-250-4200 ext 3336
FAX: 213-202-6490
ssalinas@barlow2000.org

katysuegood@gmail.com

I agree with Sharon, I haven’t seen any CMS definition but if the fracture would not have occurred in healthy bone, it would be pathologic (if the patient has underlying osteoporosis, Ca, etc). I have been told by our ortho group that virtually all our ground-level falls in elderly patients are pathologic in nature.

This article is directed at I-10 but Dr. Pinson provides a nice definition (scroll to the end of the article)

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

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

dwhite@tfhd.com

My Orthopedic physicians had referred me to these sites, for when working with our hospitalists and addressing the terminology etc:

www.bones.nih.gov
www.NOF.org

Hope this is helpful.

d