Procedure Practice 08/15/99 - Feature Article 08/15/99
   

Procedure Practice 08/15/99:
Coding Recommendations

  
Listed below are the ICD-9-CM diagnosis and procedure codes as well as the CPT-4 procedure codes that we think properly classify the treatment described. Please note that modifiers, used only for physician billing purposes, have not been assigned to the CPT-4 codes. If you disagree with our suggestions or have other comments, please send an e-mail to codingedge@lagunamedsys.com.
   

Suggested Codes and Rationale
   

Case 1:

ICD-9-Diagnosis Codes

This patient had a closed fracture of the distal radius due to a fall from a ladder. The entry for "Fracture" in the Index to Diseases lists the subheadings, "radius (alone) (closed); lower end (distal end)" and directs the coder to 813.42. Turning to the Tabular List we see that 813.42 correctly identifies this fracture: Other fractures of distal end of radius (alone); Dupuytren’s fracture, radius; Radius, lower end. Next we need to locate the correct E code for a fall from a ladder. In the Index to External Causes under the main entry "fall, falling, from" the subheading for "ladder" lists code E881.0. A review of the Tabular List code description verifies that E881.0 is the correct code: Fall from ladder.
 

ICD-9-CM Procedure Codes

The physician stated that the fracture was nondisplaced. Therefore, the fracture fragments were in good alignment and reduction was not necessary. The physician simply applied a plaster splint as a stabilizing device. Under the entry "Application" in the Index to Procedures, the coder finds 93.54 under the subentry "splint, for immobilization (plaster) (pneumatic) (tray)." The description for 93.54 verifies that it is the correct code for this procedure: Other immobilization, pressure, and attention to wound; application of splint.
  

CPT-4 Procedure Codes

To select the correct code for this procedure, we first need to understand how to code for casts and strapping in the CPT system. The CPT system provides a series of codes from 29000 through 29750 that describe the application of various immobilization devices. The explanatory notes that immediately precede this range of codes describe when they are appropriate. Codes from this range may be reported in the following treatment scenarios:

1. To identify an initial service by a physician who is not expected to provide any other treatment;
    
2. To identify an initial service when the patient will be referred to another physician for restorative treatment;
     
3. To identify an initial service performed without any restorative intent and/or to provide pain relief to the patient; and
     
4. To identify replacement of casting or strapping after the normal period of follow-up care.

The treatment notes indicate that the splint application is the definitive treatment for this patient, and that the patient will return to the same provider for follow-up care. Codes from the casting and strapping range do not apply in this case. The Index entry for "Fracture, radius, distal" lists 25600, 25605, and 25611. A review of the accompanying code descriptions shows that 25600 is the correct code: Closed treatment of distal radial fracture (e.g., Colles or Smith type) or epiphyseal separation, with or without fracture of ulnar styloid; without manipulation.

Case 2:

ICD-9-Diagnosis Codes

The patient had a closed fracture of the olecranon process of the ulna. In the Index to Diseases under "Fracture," the subheading for "ulna, olecranon process (closed)" directs the coder to 813.01. The description of this code in the Tabular List verifies that 813.01 is the correct diagnosis code: Fracture of radius and ulna, upper end, closed, olecranon process of ulna. The injury was the result of being struck while playing sports. In the Index to External Causes under the main entry "Striking against," the subheading for "object, in sports" lists code E917.0. The Tabular List code description verifies that E917.0 is the correct code: Striking against or struck accidentally by objects or persons, in sports.
 

ICD-9-CM Procedure Codes

The surgeon visualized the fracture site, manipulated the bone fragments into proper alignment, and then held the fragments in place with wires inserted directly into the bone. This procedure is an open reduction with internal fixation. In the Procedure Index the entry for "Reduction, fracture, ulna, open, with internal fixation" lists 79.32. The Tabular List description verifies that 79.32 is the correct procedure code: Open reduction of fracture with internal fixation, radius and ulna.
  

CPT-4 Procedure Codes

In the Index, the entry for "Fracture, ulna, olecranon, open treatment" directs the coder to a single code. Assign 24685, Open treatment of ulnar fracture proximal end (olecranon process), with or without internal or external fixation, for this procedure.

Case 3:

ICD-9-Diagnosis Codes

The patient had a compound proximal tibia and fibula fracture. Following the subheadings under "Fracture, tibia, upper end, with fibula, open," we arrive at code 823.12. The code’s description confirms that 823.12 correctly identifies this injury: Fracture of upper end, open, fibula with tibia. Again, an E-code is needed to identify the cause of injury. In this case, we have a motor vehicle accident in which the patient was a pedestrian crossing the street. In the Index to External Causes the entry for "Accident, motor vehicle (on public highway) (traffic)" lists E819 and indicates the need for a 5th digit. The correct code is E819.7, Motor vehicle traffic accident of unspecified nature, pedestrian.
 

ICD-9-CM Procedure Codes

This patient underwent fracture site debridement followed by closed reduction and cast application. The Procedure Index lists 79.66 under the entry for "Debridement, open fracture, tibia." The description verifies that 79.66 is the correct code: Debridement of open fracture site, tibia and fibula. The closed reduction must also be coded. The code 79.06 is found under the Index entry for "Reduction, fracture, tibia, closed." Code 79.06 is the correct code for the reduction procedure: Closed reduction of fracture, includes application of cast or splint, without internal fixation, tibia and fibula.
  

CPT-4 Procedure Codes

The surgeon debrided skin, fascia, muscle, and bone. Debridement of a fracture site must be coded separately because it is distinct from fracture reduction and/or stabilization. In the Index the entry for "Debridement, skin, with open fracture and/or dislocation" refers the coder to codes 11010-11012. After carefully reading the descriptions for all three codes this range, only 11012 identifies all the tissues debrided during this procedure: Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s); skin, subcutaneous tissue, muscle fascia, muscle, and bone. Next we need a code for the closed reduction. The Index entry for "Fracture, tibia, closed treatment" lists a variety of possible codes. After reading the accompanying text for all suggested codes, 27532 is the code that describes the procedure performed: Closed treatment of tibial fracture, proximal (plateau); with or without manipulation, with skeletal traction.

Procedure Practice 08/15/99 - Feature Article 08/15/99