Coding pathological fracturs

jenniferan@mcmc.net

My inpatient coder will not code a pathological fracture when the patient has a history of osteoporosis unless the doctor stipulates that it is a pathological fracture.   The official guidelines state ' A code from category M80, not a traumatic fracture code should be used for any patient with known osteoporosis  who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal healthy bone.' Am I right in coding it to age related osteoporosis with pathological fracture with every patient that has a history of osteoporosis and has indeed incurred a fracture or does the physician still have to link them. Thank you

vparent@emhs.org

Our practice is to have the physician make the connection in the documentation. We do not code from the history.

evanspx@sutterhealth.org

If Osteoporosis is not curable and does not reverse itself..in my view,  we should code a pathological fracture in a patient with stated 'history' of osteoporosis.

evanspx@sutterhealth.org

Paraphrasing as I do not want to type long message:  ICD Official Guidelines,  pg 55, FY 2018

"A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture...

rmendoza

If a patient has a history of osteoporosis and still being treated with Fosamax or other medication, then it is still being actively treated and still can be captured and linked to the fracture if applicable.