Coding fractures in ICD10: Difference between revisions

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~~== Coding instructions ==~~

There are two main categories of fractures:

*~~Usually~~ a ~~fracture will also be associated with one or more~~ ''~~other~~'' ~~diagnosis codes~~.

*[[#Fractures due to trauma or injury]] -- by definition these have a so-called '''external''' cause or mechanism of injury". This means that the fracture was due to something external to the patient, such as getting hit by a baseball bat, or hitting their head on the pavement after falling off a ladder.

*~~For example, since most~~ fractures ~~are traumas~~, ~~in those cases you should also code the mechanism of injury~~. ~~See: {{ListICD10Category | categoryName = Mechanism}}~~

*[[#Nontraumatic fractures]] -- for these the main cause is something ''internal'' to the patient, such as a metastatic tumor to bone that weakens it.

*If the ~~mechanism~~ of ~~injury is unknown~~ or ~~not among those listed~~, ~~use '''[[Mechanism~~ of ~~injury: other NOS]]'''~~

**While in these cases the fracture might well happen after some relatively minor stress to that bone (e.g. trying to open a jar of pickles, or lifting a heavy book), these should be included in the nontraumatic fracture category unless that stress would have led to a fracture in the absence of whatever weakened the bone.

*If it's a ~~nontraumatic~~ fracture, you ~~should~~ also code the ~~cause~~, e.g:

===Fractures due to trauma or injury===

**[[Bone, pathologic fracture due to neoplastic disease]]

*These codes for traumatic fractures include BOTH closed and open fractures --- i.e. for an open fracture there is no need to additionally code the soft tissue injury that overlies it and renders it "open"

**[[~~Osteoporosis~~ with new pathologic fracture]]

**If a fracture, particularly an open fracture, is or becomes infected, then also code the infection

**[[Bone, stress fracture]]

*For fractures due to ''external causes'' i.e. trauma or injury, there are specific codes identifying the bone in question.

**[[Bone, ~~pathologic~~ fracture NOS]]

**Some of these are specific for a single bone, e.g: '''[[Femur, fracture, injury/trauma]]'''

**[[Bone, disorder of bone continuity]]

**Others identify a group of related bones, e.g: '''[[Ankle or foot or toes, fracture, injury/trauma]]'''

**And some are for when you only know the general region, e.g: '''[[Upper limb (arm) bones, level not specified/NOS, fracture, injury/trauma]]'''

*'''''For all such fractures''''', you MUST also code the mechanism of traumatic injury.

**If the mechanism of trauma is unknown or not among those listed, use '''[[Mechanism of injury: other NOS]]'''

===Nontraumatic fractures===

Here there are fewer codes, and the only bones for which we have specific codes are femur/pelvis and vertebrae. Nontraumatic fractures fall into 4 main subcategories:

# Pathologic fractures due to neoplastic disease -- here a neoplasm involving bone is the factor that weakened the bone.

#*[[Femur or pelvis, pathologic fracture due to neoplastic disease]]

#*[[Vertebra, pathologic fracture due to neoplastic disease]]

#*[[Bone NOS, pathologic fracture due to neoplastic disease]]

# Pathologic fractures due to osteoporosis -- here osteoporosis is the factor that weakened the bone.

#*[[Femur or pelvis, osteoporosis with new pathologic fracture]]

#*[[Vertebra, osteoporosis with new pathologic fracture]]

#*[[Bone NOS, osteoporosis with new pathologic fracture]]

# Stress fractures -- note here we have just one code, no codes for specific bones (i.e. it's one-size-fits-all for this type of fracture). These are due to repetitive stress rather than a single big event.

#*[[Bone, stress fracture]]

# Nontraumatic fractures NOS -- these are for nontraumatic fractures that don't fit into the other categories listed immediately above.

#*[[Femur or pelvis, nontraumatic fracture NOS]]

#*[[Vertebra, nontraumatic fracture NOS]] -- this includes vertebral compression/wedge fractures not due to neoplasm or osteoporosis.

#*[[Bone NOS, nontraumatic fracture NOS]]

==== Related conditions ====

* [[Bone, disorder of bone continuity NOS]]

* [[Skeletal and/or muscular system NOS, congenital malformation/deformity]]

[[Category:ICD10]]

[[Category:Fracture | * ]]

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-== Coding instructions ==
+There are two main categories of fractures:
-*Usually a fracture will also be associated with one or more ''other'' diagnosis codes.
+*[[#Fractures due to trauma or injury]] -- by definition these have a so-called '''external''' cause or mechanism of injury".  This means that the fracture was due to something external to the patient, such as getting hit by a baseball bat, or hitting their head on the pavement after falling off a ladder.
-*For example, since most fractures are traumas, in those cases you should also code the mechanism of injury.  See: {{ListICD10Category | categoryName = Mechanism}}
+*[[#Nontraumatic fractures]] -- for these the main cause is something ''internal'' to the patient, such as a metastatic tumor to bone that weakens it.
-*If the mechanism of injury is unknown or not among those listed, use '''[[Mechanism of injury: other NOS]]'''
+**While in these cases the fracture might well happen after some relatively minor stress to that bone (e.g. trying to open a jar of pickles, or lifting a heavy book), these should be included in the nontraumatic fracture category unless that stress would have led to a fracture in the absence of whatever weakened the bone.
-*If it's a nontraumatic fracture, you should also code the cause, e.g:
+===Fractures due to trauma or injury===
-**[[Bone, pathologic fracture due to neoplastic disease]]
+*These codes for traumatic fractures include BOTH closed and open fractures --- i.e. for an open fracture there is no need to additionally code the soft tissue injury that overlies it and renders it "open"
-**[[Osteoporosis with new pathologic fracture]]
+**If a fracture, particularly an open fracture, is or becomes infected, then also code the infection
-**[[Bone, stress fracture]]
+*For fractures due to ''external causes'' i.e. trauma or injury, there are specific codes identifying the bone in question.
-**[[Bone, pathologic fracture NOS]]
+**Some of these are specific for a single bone, e.g:  '''[[Femur, fracture, injury/trauma]]'''
-**[[Bone, disorder of bone continuity]]
+**Others identify a group of related bones, e.g:  '''[[Ankle or foot or toes, fracture, injury/trauma]]'''
+**And some are for when you only know the general region, e.g: '''[[Upper limb (arm) bones, level not specified/NOS, fracture, injury/trauma]]'''
+{{ListICD10Category | categoryName = Traumatic fracture}}
+*'''''For all such fractures''''', you MUST also code the mechanism of traumatic injury.
+**If the mechanism of trauma is unknown or not among those listed, use '''[[Mechanism of injury: other NOS]]'''
+{{ListICD10Category | categoryName = Mechanism}}
+===Nontraumatic fractures===
+Here there are fewer codes, and the only bones for which we have specific codes are femur/pelvis and vertebrae.  Nontraumatic fractures fall into 4 main subcategories:
+# Pathologic fractures due to neoplastic disease -- here a neoplasm involving bone is the factor that weakened the bone.
+#*[[Femur or pelvis, pathologic fracture due to neoplastic disease]]
+#*[[Vertebra, pathologic fracture due to neoplastic disease]]
+#*[[Bone NOS, pathologic fracture due to neoplastic disease]]
+# Pathologic fractures due to osteoporosis -- here osteoporosis is the factor that weakened the bone.
+#*[[Femur or pelvis, osteoporosis with new pathologic fracture]]
+#*[[Vertebra, osteoporosis with new pathologic fracture]]
+#*[[Bone NOS, osteoporosis with new pathologic fracture]]
+# Stress fractures -- note here we have just one code, no codes for specific bones (i.e. it's one-size-fits-all for this type of fracture).  These are due to repetitive stress rather than a single big event.
+#*[[Bone, stress fracture]]
+# Nontraumatic fractures NOS -- these are for nontraumatic fractures that don't fit into the other categories listed immediately above.
+#*[[Femur or pelvis, nontraumatic fracture NOS]]
+#*[[Vertebra, nontraumatic fracture NOS]] -- this includes vertebral compression/wedge fractures not due to neoplasm or osteoporosis.
+#*[[Bone NOS, nontraumatic fracture NOS]]
+==== Related conditions ====
+* [[Bone, disorder of bone continuity NOS]]
+* [[Skeletal and/or muscular system NOS, congenital malformation/deformity]]
 [[Category:ICD10]]
+[[Category:Fracture | * ]]