Documenting and Coding Hip Fractures Using ICD-10

Hip fractures are cracks or breaks in the top of the thigh bone (femur) close to the hip joint. Generally, the condition is caused by a fall or an injury to the side of the hip, but may occasionally be caused by a health condition (such as cancer) that weakens the hip bone. In severe cases, it is possible for the hip to break with the patient merely standing on the leg and twisting. The condition is more common among people aged 65 years and older and is more prevalent in women who are prone to a disease that weakens bones (called osteoporosis). There are two different types of fractures namely – intracapsular, and extracapsular. While many of them are clinically and radiologically obvious, there are few fractures that are more difficult to diagnose. In some cases, even repeat X-rays, CTs and MRIs may be required to confirm the diagnosis. Apart from the complications in establishing the correct diagnosis, reporting and documenting hip fractures is rather complex. Relying on the services of a dedicated medical billing and coding company is vital to get the correct ICD-10 codes reported on your medical claims.

According to reports from the Centers for Disease Control and Prevention (CDC), more than 300,000 American adults aged 65 and older are hospitalized each year for hip fractures. More than 95 percent of these fractures are caused by falling, (usually falling sideways). A hip fracture can cause hip pain, swelling or bruising, and the hip may look deformed. It may be difficult to move the hip, especially turning the foot outwards or bending at the hip. Some of the major symptoms that occur as a result of fracture of the hip include – inability to get up from a fall or to walk, severe pain in your hip or groin, inability to put weight on your leg (on the side of your injured hip), shorter leg on the side of your injured hip and experiencing severe discomfort when trying to move or rotate your hip. If left untreated or a hip fracture keeps a person immobile for a long time, it can result in severe complications like blood clots in the legs, bed sores, urinary tract infections, further loss of muscle mass (increasing the patient’s risk of falls and injuries) and even death.

Diagnosing Different Types of Fractures

• Intracapsular fracture - An intracapsular fracture is a bone fracture located within the joint capsule. In this type, the break occurs below the ball or in the neck of the femur. Examples of intracapsular fractures in the hip include - fractures of the femoral head and femoral neck.

• Extracapsular fracture – This is a type of bone fracture near a joint but still located outside the joint capsule. Extracapsular fractures are further classified into - intertrochanteric and subtrochanteric. In intertrochanteric - the break occurs between the greater trochanter and lesser trochanter and in subtrochanteric – the break occurs below the lesser trochanter or further down the femur.

In most cases, the diagnosis of this condition can be made based on the symptoms and the abnormal position of the patient’s hip and leg. As an initial procedure, an X-ray of the hip will be taken to confirm whether there is a fracture and show where the fracture is actually located. In some cases, if the X-ray doesn't show a fracture but the patient still has hip pain, the physician or orthopedist may recommend doing an MRI or bone scan to look for a hairline fracture. Treatment for hip fracture usually involves a combination of surgery, rehabilitation and medication.

The National Institute for Health and Care Excellence (NICE) recommends that a person with a hip fracture should have surgery within 48 hours of admission to a hospital. However, surgery may sometimes be delayed if the person is unwell with some other health condition and treating that condition first will significantly improve the outcome of their hip surgery. In about half of all cases, a partial or complete hip replacement is needed. The other cases require surgery to fix the fracture with plates and screws or rods.

The type of surgery generally depends on several factors like – the type of fracture (where on the femur it is), severity of the fracture, whether the broken bones aren't properly aligned (displaced), patient age and their underlying bone and joint conditions. Rehabilitation techniques include - physical therapy – which will initially focus on range-of-motion and strengthening exercises. Depending on the type of surgery a person underwent and whether they have help at home, they may need to go from the hospital to an extended care facility.

ICD-10 Coding for Hip Fractures

Orthopedists or other bone specialists who happen to diagnose and treat different types of hip fractures need to document the symptoms, screening tests and other treatment procedures administered using the correct medical codes. Billing and coding services offered by reputable medical billing and coding companies can help physicians use the right ICD-10 codes for their billing purposes. ICD-10 codes for diagnosing hip fractures include -

• M84.459 - Pathological fracture, hip, unspecified
• M84.459A - Pathological fracture, hip, unspecified, initial encounter for fracture
• M84.459D - Pathological fracture, hip, unspecified, subsequent encounter for fracture with routine healing
• M84.459G - Pathological fracture, hip, unspecified, subsequent encounter for fracture with delayed healing
• M84.459K - Pathological fracture, hip, unspecified, subsequent encounter for fracture with nonunion
• M84.459P - Pathological fracture, hip, unspecified, subsequent encounter for fracture with malunion
• M84.459S - Pathological fracture, hip, unspecified, sequela

Intracapsular Fractures

Intracapsular fractures are termed as fractures of the ‘neck of femur’ (NOF) which include fractures below the femoral head (subcapital), across the mid-femoral neck (transcervical) or fractures across the base of the femoral neck (basicervical). You need to choose an appropriate code that reflects the type of fracture (open or closed), laterality (left or right), episode of care (initial, subsequent and sequela) and complications (delayed healing, non-union, malunion). ICD-10 codes for diagnosing Intracapsular Fractures -

• S72.012 - Unspecified intracapsular fracture of left femur
• S72.012A - Unspecified intracapsular fracture of left femur, initial encounter for closed fracture
• S72.012B - Unspecified intracapsular fracture of left femur, initial encounter for open fracture type I or II
• S72.012C -Unspecified intracapsular fracture of left femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
• S72.012D - Unspecified intracapsular fracture of left femur, subsequent encounter for closed fracture with routine healing
• S72.012E - Unspecified intracapsular fracture of left femur, subsequent encounter for open fracture type I or II with routine healing
• S72.012F - Unspecified intracapsular fracture of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
• S72.012G -Unspecified intracapsular fracture of left femur, subsequent encounter for closed fracture with delayed healing
• S72.012H - Unspecified intracapsular fracture of left femur, subsequent encounter for open fracture type I or II with delayed healing
• S72.012J - Unspecified intracapsular fracture of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
• S72.012K - Unspecified intracapsular fracture of left femur, subsequent encounter for closed fracture with nonunion
• S72.012M - Unspecified intracapsular fracture of left femur, subsequent encounter for open fracture type I or II with nonunion
• S72.012N - Unspecified intracapsular fracture of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
• S72.012P - Unspecified intracapsular fracture of left femur, subsequent encounter for closed fracture with malunion
• S72.012Q - Unspecified intracapsular fracture of left femur, subsequent encounter for open fracture type I or II with malunion
• S72.012R - Unspecified intracapsular fracture of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
• S72.012S - Unspecified intracapsular fracture of left femur, sequela

Extracapsular Fractures

Extracapsular fractures include intertrochanteric (between the trochanters) and subtrochanteric (distal to the trochanters). Such fractures do not involve the neck of the femur. It is important to consider the type of fracture, laterality and episode of care. There are separate codes for intertrochanteric and subtrochanteric fractures–

Intertrochanteric

S72.14 - Intertrochanteric fracture of femur

• S72.141 - Displaced intertrochanteric fracture of right femur
• S72.141A - Displaced intertrochanteric fracture of right femur, initial encounter for closed fracture
• S72.141B - Displaced intertrochanteric fracture of right femur, initial encounter for open fracture type I or II
• S72.141C - Displaced intertrochanteric fracture of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
• S72.141D - Displaced intertrochanteric fracture of right femur, subsequent encounter for closed fracture with routine healing
• S72.141E - Displaced intertrochanteric fracture of right femur, subsequent encounter for open fracture type I or II with routine healing
• S72.141F - Displaced intertrochanteric fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
• S72.141G - Displaced intertrochanteric fracture of right femur, subsequent encounter for closed fracture with delayed healing
• S72.141H - Displaced intertrochanteric fracture of right femur, subsequent encounter for open fracture type I or II with delayed healing
• S72.141J - Displaced intertrochanteric fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
• S72.141K - Displaced intertrochanteric fracture of right femur, subsequent encounter for closed fracture with nonunion
• S72.141M - Displaced intertrochanteric fracture of right femur, subsequent encounter for open fracture type I or II with nonunion
• S72.141N - Displaced intertrochanteric fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
• S72.141P - Displaced intertrochanteric fracture of right femur, subsequent encounter for closed fracture with malunion
• S72.141Q - Displaced intertrochanteric fracture of right femur, subsequent encounter for open fracture type I or II with malunion
• S72.141R - Displaced intertrochanteric fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
• S72.141S - Displaced intertrochanteric fracture of right femur, sequela

Subtrochanteric

S72.2 - Subtrochanteric fracture of femur

• S72.21 - Displaced subtrochanteric fracture of right femur
• S72.21XA - Displaced subtrochanteric fracture of right femur, initial encounter for closed fracture
• S72.21XB - Displaced subtrochanteric fracture of right femur, initial encounter for open fracture type I or II
• S72.21XC - Displaced subtrochanteric fracture of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
• S72.21XD - Displaced subtrochanteric fracture of right femur, subsequent encounter for closed fracture with routine healing
• S72.21XE - Displaced subtrochanteric fracture of right femur, subsequent encounter - for open fracture type I or II with routine healing
• S72.21XF - Displaced subtrochanteric fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
• S72.21XG - Displaced subtrochanteric fracture of right femur, subsequent encounter for closed fracture with delayed healing
• S72.21XH - Displaced subtrochanteric fracture of right femur, subsequent encounter for open fracture type I or II with delayed healing
• S72.21XJ - Displaced subtrochanteric fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
• S72.21XK - Displaced subtrochanteric fracture of right femur, subsequent encounter for closed fracture with nonunion
• S72.21XM - Displaced subtrochanteric fracture of right femur, subsequent encounter for open fracture type I or II with nonunion
• S72.21XN - Displaced subtrochanteric fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
• S72.21XP - Displaced subtrochanteric fracture of right femur, subsequent encounter for closed fracture with malunion
• S72.21XQ - Displaced subtrochanteric fracture of right femur, subsequent encounter for open fracture type I or II with malunion
• S72.21XR - Displaced subtrochanteric fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
• S72.21XS - Displaced subtrochanteric fracture of right femur, sequela

While coding for these types of fractures, it is also important to consider the complications associated with intertrochanteric (rarely, nonunion or malunion, degenerative changes) and subtrochanteric (high rates of nonunion and implant, fatigue as a result of high physical stress in the region) to ensure correct coding and quick reimbursement. Consider utilizing outsourced medical coding services from professional and certified billing and coding experts, for better outcomes.