Fractures (Traumatic) ICD-10-CM codes

Every traumatic fracture code needs a seventh character that reports the episode of care and the healing status. For most bones the choices are A initial encounter for closed fracture, B initial encounter for open fracture, D subsequent encounter with routine healing, G subsequent with delayed healing, K subsequent with nonunion, P subsequent with malunion, and S sequela. When the code has fewer than six characters, X fills the empty positions, as in S22.31XA (fracture of one rib, right side, initial encounter, closed). Initial means the patient is receiving active treatment (emergency care, surgery, evaluation by a new provider), and subsequent covers the healing phase such as cast changes and follow-up visits. Aftercare Z codes are not used for fractures.

The femur (S72), forearm (S52), and lower leg including ankle (S82) use an expanded set of seventh characters that adds the Gustilo open fracture classification: A closed, B open type I or II, C open type IIIA, IIIB, or IIIC for the initial encounter, then D, E, F for routine healing, G, H, J for delayed healing, K, M, N for nonunion, P, Q, R for malunion, and S for sequela. Defaults from the official guidelines: a fracture not documented as open or closed is coded as closed, one not documented as displaced or nondisplaced is coded as displaced, and an open fracture without a Gustilo type takes the type I or II character.

Category S42.0 shows the usual fourth to sixth character structure: part of the bone (S42.00 unspecified, S42.01 sternal end, S42.02 shaft, S42.03 lateral end), displacement, and laterality (S42.021A displaced shaft fracture of right clavicle, S42.024A nondisplaced). Rib fractures use S22.3- for one rib and S22.4- for multiple ribs with laterality, and S22.5XXA for flail chest. Multiple fractures are sequenced by severity.

Fractures from osteoporosis or disease are not S codes. Per the guidelines, a patient with known osteoporosis who fractures a bone after a fall or trauma that would not break a healthy bone is coded to M80 (M80.00XA unspecified site, M80.08XA vertebra), and stress fractures are M84.3- (M84.375A left foot). A healed fracture with no current problem is Z87.81. Add the external cause code (W19.XXXA unspecified fall, W01.0XXA fall from slipping or tripping) and place of occurrence when documented.