Coding fractures in ICD10

Coding instructions

There are two main categories of fractures:

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

Fractures due to trauma or injury

• For fractures due to external causes i.e. trauma or injury, there are specific codes identifying the bone in question.
  • Some of these are specific for a single bone, e.g: Femur, fracture, injury/trauma
  • 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:

1. 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
2. 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
3. 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
4. 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

Also sometimes relevant will be: Bone, disorder of bone continuity NOS