273 Chapter-specific coding guidelines for physician coding and reporting are provided in Section IV of International Classification of Diseases, Ninth Revision, Clinical Modi- fication (ICD-9-CM) and International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). It is important that these guidelines be reviewed carefully prior to implementation of ICD-10-CM because they are considerably different from ICD-9-CM coding guidelines for fracture care and aftercare. ICD-10-CM Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes (S00–T88) Coding Traumatic Fractures The principles of multiple coding of injuries should be followed in coding fractures. Fractures of specified sites are coded individually by site in accordance with provisions within categories of ICD-10-CM codes and supporting documentation in the medical record. Appendix B-21 Coding for Traumatic Fractures –– S02 (fracture of skull and facial bones) S12 (fracture of cervical vertebra and other parts of the neck) S22 (fracture of rib, sternum, and thoracic spine) –– S32 (fracture of lumbar spine and pelvis) –– S42 (fracture of shoulder and upper arm) S49 (other and unspecified injuries of shoulder and upper arm) S52 (fracture of forearm) S59 (other and unspecified injuries of elbow and forearm) –– S62 (fracture at wrist and hand level) –– S72 (fracture of femur) S79 (other and unspecified injuries of hip and thigh) –– S82 (fracture of lower leg and ankle) S89 (other and unspecified injuries of lower leg) S92 (fracture of foot and toe, except ankle) A fracture that is not documented as open or closed should be coded as a closed fracture. A fracture that is not documented as displaced or not displaced cannot be coded as displaced. Codes for multiple fractures are sequenced in accordance with the severity of the fracture. Traumatic fractures are coded using an appropriate seventh character code. Initial Encounters for Fracture Care The initial encounter for active treatment of the fracture (eg, surgical treatment, emergency department encounter, evaluation and treatment by a new physician) is reported using seventh character code A, B, or C. Seventh character codes A, B, and C are also used to identify the initial encounter for the patient who delayed seeking treatment for an open or closed fracture. A: Initial encounter for closed fracture B: Initial encounter for open fracture type I or II Initial encounter for open fracture not otherwise specified C: Initial encounter for open fracture type IIIA, IIIB, or IIIC (continued on page 274)
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