ICD-10-CM and Open Fractures

ICD-10-CM provides a wealth of opportunities for coding fractures. From traumatic to pathological, open or closed, displaced, greenstick, spiral and stable burst; anatomical left/right, proximal, shaft or distal—all of these descriptors and more may be used to code fracture bones. This discussion will focus on open fractures.

Open Fractures

Open fractures, particularly of long bones in the forearm, upper and lower legs may be coded with a high degree of specificity using ICD-10-CM codes, which utilize the Gustilo & Anderson Classification of Open Fractures.  

The following are descriptive examples of Gustilo & Anderson classifications available for coding open fractures in ICD-10-CM:

• Type I: Clean wound, <1 cm, low impact with minimal soft tissue injury (e.g. simple transverse, oblique);
• Type II: Wound >1 cm with moderate soft tissue damage;
• Type III: The wound is > 10 cm, with extensive soft tissue disruption/contamination. May include high velocity injury, farm injuries, delayed treatment (e.g. crushed by ATV or tractor, shotgun wound, high-speed vehicle). 

Type III open fractures of the forearm, upper and lower leg may be further classified into:

• III A: Soft tissue coverage of the fractured bone is adequate.
• III B: Extensive injury to or loss of soft tissue, with periosteal stripping and exposure of bone, contamination, and severe comminution of the fracture. After debridement and irrigation a flap or graft is necessary for coverage.
• III C: Any open fracture requiring vascular repair to save the limb, regardless of the degree of soft tissue injury.

Coding Tips for Fractures:  

• If a fracture description does not specify open or closed, the coder will default to closed.
• If the description does not specify displaced or non-displaced, the coder will default to displaced.
• If the description does not specify the type of open fracture, the coder will default to Type I/II. 
• Multiple fractures are sequenced by the severity of the fracture.

Initial care 7^th character codes “A” (closed fracture) or “B” (open fracture Gustilo Type I or II, or unspecified) or “C” (open fracture Gustilo Type IIIA, IIIB, or IIIC) indicate the patient is receiving active treatment for the fracture.  It is appropriate to use initial evaluation and treatment suffix “A” when the patient has been transferred from another facility to a higher level trauma facility for active management of the fracture.

For additional information on ICD-10 coding for emergency medicine, visit the ACEP Reimbursement page. 

08/2015