FW: Pathologic fracture due to osteoporosis without a dexascan or confirmed osteoporosis diagnosis..
Hi all, Hoping someone can help me with this. Thanks very much in advance. I had put this question out previously and thought I would put this out there again. Thanks for taking the time if you have any information. I think I didn't ask the question well initially.
My question is, Can (Is it appropriate/standard of practice) a physician document 'pathologic fracture due to Osteoporosis'...... when there is NO definitive diagnosis of Osteoporosis prior to the fracture. There has never been a Dexascan to confirm the diagnosis.
Example: Pt 54 has ground level fall and fractures hip. My orthopedic physician assistant felt that based on the 'Own the bone' etc literature that you could presume osteoporosis based on mechanism of injury....without any other definitive diagnostic test to confirm osteoporosis. The ortho surgeons however ....aren't sure that you can and aren't comfortable doing that. Thoughts? Any literature to support either side out there? Would it be appropriate without a confirmed diagnosis....and just based on the mechanism being GLF in pt >50 yrs old to state Pathological fracture due to possible Osteoporosis?
If so, does anyone have any literature to support this? My physicians are wanting to see some literature before they would begin this..
I do understand from below which was sent as a response (thank you!), that if the osteoporosis was previously diagnosed that a link would be assumed with icd10. But the situations I am asking about is when there is NO prior confirmed diagnosis of osteoporosis.
Thanks very much.
Debbie
Sent: Wednesday, November 04, 2015 1:10 PM
To: White, Deborah
Subject: I saw your question about pathologic fracture on the CDI talk site...
Hi Deborah,
Just wanted to share this... In ICD-10 Pathologic is now an assumed link,
http://www.hcpro.com/HIM-276556-3288/Variations-in-ICD10-documentation-requirements-and-coding-guidance-highlight-need-for-Coding-Clinic-advice.html
Guidance varies regarding cause-and-effect relationship
The 2012 ICD-10-CM Official Guidelines for Coding and Reporting contains advice regarding the proper application of diagnosis codes from specific code categories. One example is how to correctly code a case in which the patient has both osteoporosis and a current pathological fracture. Currently, there is not an "assumed" cause-effect relationship in ICD-9-CM between an acute (i.e., new) fracture and osteoporosis. In other words, the terms "fracture" and "osteoporosis" documented on the same record do not equate to a diagnosis of "pathological fracture." A physician must clearly document this cause-effect relationship with terms such as "osteoporotic fracture", "fracture due to/associated with osteoporosis", or similar language. Without this link, the CDI specialist or coder must query the physician.
In ICD-10-CM, however, this cause-effect relationship is assumed, supported by the following guidance from the ICD-10-CM Official Guidelines for Coding and Reporting (I.C.13.d.2):
Category M80, Osteoporosis with current pathological fracture, is for patients who have a current pathologic fracture at the time of an encounter. The codes under M80 identify the site of the fracture. 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.
This guidance clearly directs the coder to assign the code for "pathological fracture," supporting an assumed cause-effect relationship between "fracture" and "osteoporosis." This represents the type of advice that is based on Coding Clinic advice over the years, and it is certain that coders and documentation specialists will welcome this explicit direction from the AHA because it averts the need for a provider query.
Hope that helps!
Elizabeth
From: White, Deborah
Sent: Tuesday, November 03, 2015 12:00 PM
To: 'cdi_talk@hcprotalk.com'
Subject: Pathologic fracture due to osteoporosis without a dexascan...how do you handle?
My orthopedic physicians don't feel comfortable stating 'pathologic fracture due to osteoporosis' if they don't have a dexascan or other definitive diagnosis for the osteoporosis.
They are open to changing if I can give them some literature that it is standard of practice to do this.
They are aware of: Own the Bone/American Osteopathic Association (AOA)/National Osteoporosis Association (NOF) state to start Vitamin D and Ca in patients
My question is, Can (Is it appropriate/standard of practice) a physician document 'pathologic fracture due to Osteoporosis'...... when there is NO definitive diagnosis of Osteoporosis prior to the fracture. There has never been a Dexascan to confirm the diagnosis.
Example: Pt 54 has ground level fall and fractures hip. My orthopedic physician assistant felt that based on the 'Own the bone' etc literature that you could presume osteoporosis based on mechanism of injury....without any other definitive diagnostic test to confirm osteoporosis. The ortho surgeons however ....aren't sure that you can and aren't comfortable doing that. Thoughts? Any literature to support either side out there? Would it be appropriate without a confirmed diagnosis....and just based on the mechanism being GLF in pt >50 yrs old to state Pathological fracture due to possible Osteoporosis?
If so, does anyone have any literature to support this? My physicians are wanting to see some literature before they would begin this..
I do understand from below which was sent as a response (thank you!), that if the osteoporosis was previously diagnosed that a link would be assumed with icd10. But the situations I am asking about is when there is NO prior confirmed diagnosis of osteoporosis.
Thanks very much.
Debbie
Sent: Wednesday, November 04, 2015 1:10 PM
To: White, Deborah
Subject: I saw your question about pathologic fracture on the CDI talk site...
Hi Deborah,
Just wanted to share this... In ICD-10 Pathologic is now an assumed link,
http://www.hcpro.com/HIM-276556-3288/Variations-in-ICD10-documentation-requirements-and-coding-guidance-highlight-need-for-Coding-Clinic-advice.html
Guidance varies regarding cause-and-effect relationship
The 2012 ICD-10-CM Official Guidelines for Coding and Reporting contains advice regarding the proper application of diagnosis codes from specific code categories. One example is how to correctly code a case in which the patient has both osteoporosis and a current pathological fracture. Currently, there is not an "assumed" cause-effect relationship in ICD-9-CM between an acute (i.e., new) fracture and osteoporosis. In other words, the terms "fracture" and "osteoporosis" documented on the same record do not equate to a diagnosis of "pathological fracture." A physician must clearly document this cause-effect relationship with terms such as "osteoporotic fracture", "fracture due to/associated with osteoporosis", or similar language. Without this link, the CDI specialist or coder must query the physician.
In ICD-10-CM, however, this cause-effect relationship is assumed, supported by the following guidance from the ICD-10-CM Official Guidelines for Coding and Reporting (I.C.13.d.2):
Category M80, Osteoporosis with current pathological fracture, is for patients who have a current pathologic fracture at the time of an encounter. The codes under M80 identify the site of the fracture. 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.
This guidance clearly directs the coder to assign the code for "pathological fracture," supporting an assumed cause-effect relationship between "fracture" and "osteoporosis." This represents the type of advice that is based on Coding Clinic advice over the years, and it is certain that coders and documentation specialists will welcome this explicit direction from the AHA because it averts the need for a provider query.
Hope that helps!
Elizabeth
From: White, Deborah
Sent: Tuesday, November 03, 2015 12:00 PM
To: 'cdi_talk@hcprotalk.com'
Subject: Pathologic fracture due to osteoporosis without a dexascan...how do you handle?
My orthopedic physicians don't feel comfortable stating 'pathologic fracture due to osteoporosis' if they don't have a dexascan or other definitive diagnosis for the osteoporosis.
They are open to changing if I can give them some literature that it is standard of practice to do this.
They are aware of: Own the Bone/American Osteopathic Association (AOA)/National Osteoporosis Association (NOF) state to start Vitamin D and Ca in patients
Comments
The issue is to identify people with osteoporosis who are at high risk of having pathologic fracture. The fact that a patient has a fracture with no significant trauma (as Birdie had in this film) only says that the doc should look for a pathologic process. The presence of a fracture with insignificant trauma does NOT imply that the patient has osteoporosis. The Radiologist can tell if, at the fracture site, there is significant osteopenia or if there is a metastatic prostate tumor or multiple myeloma lesion or a bone cyst or genetic deformity or lots of other processes. If one wants to diagnose primary or secondary causes of osteoporosis, the osteopenia finding on the x-ray could lead the Orthopedic team to do the appropriate studies. A ground level fall fracture may or may not be enough to diagnose pathologic fracture. Most wrist fractures are from ground level falls and they are traumatic.
You can't presume osteoporosis based on mechanism of injury. You have to look at the fracture site and see if there's a pathologic process and then diagnose it.
Howzzat?
Robert S. Gold, MD
CEO, DCBA, Inc
4611 Brierwood Place
Atlanta, GA 30360
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 10, 2015 8:11 AM
To: White, Deborah
Subject: RE:[cdi_talk] Pathologic fracture due to osteoporosis without a dexascan or confirmed osteoporosis diagnosis...how do you handle?
This is great to watch:
The issue is to identify people with osteoporosis who are at high risk of having pathologic fracture. The fact that a patient has a fracture with no significant trauma (as Birdie had in this film) only says that the doc should look for a pathologic process. The presence of a fracture with insignificant trauma does NOT imply that the patient has osteoporosis. The Radiologist can tell if, at the fracture site, there is significant osteopenia or if there is a metastatic prostate tumor or multiple myeloma lesion or a bone cyst or genetic deformity or lots of other processes. If one wants to diagnose primary or secondary causes of osteoporosis, the osteopenia finding on the x-ray could lead the Orthopedic team to do the appropriate studies. A ground level fall fracture may or may not be enough to diagnose pathologic fracture. Most wrist fractures are from ground level falls and they are traumatic.
You can't presume osteoporosis based on mechanism of injury. You have to look at the fracture site and see if there's a pathologic process and then diagnose it.
Howzzat?
Robert S. Gold, MD
CEO, DCBA, Inc
4611 Brierwood Place
Atlanta, GA 30360