1. The Complete Diagnosis Coding Book by Shelley C
The Complete Diagnosis Coding Book by Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA
Chapter 8
Coding Orthopedics
McGraw Hill/Irwin
Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved

2. Learning Outcomes Distinguish between a fracture and a dislocation.
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Learning Outcomes
Distinguish between a fracture and a dislocation.
Determine if a fracture is open or closed.
Identify the appropriate segment of anatomical site involved.

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Learning Outcomes
Differentiate between pathological, spontaneous, and stress fractures.
Apply the guidelines for coding late effects of fractures.
Discern between an open and closed dislocation.

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Introduction
Conditions that affect the musculoskeletal system, such as a fracture or dislocation, can dramatically affect an individual’s quality of life.

5. Congenital Conditions
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Congenital Conditions
Musculoskeletal conditions that occur during gestation include:
Clubfoot
Hip dysplasia
Muscular dystrophy
These are coded not from this section but from the section on congenital anomalies.

6. Traumatic Fractures First Three Digits: Anatomical site 800–804 Skull
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Traumatic Fractures
First Three Digits: Anatomical site
800–804 Skull
805–809 Neck and Trunk
810–819 Upper limb
820–829 Lower limb

7. Traumatic Fractures Fourth Digit: Open or Closed
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Traumatic Fractures
Fourth Digit: Open or Closed
Open: Broken bone protrudes through skin.
Also called: Compound, Infected, Missile, Puncture, With Foreign Body

8. Traumatic Fractures Fourth Digit: Open or Closed
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Traumatic Fractures
Fourth Digit: Open or Closed
Closed: Contained within the skin
Also called: Comminuted, Depressed, Elevated, Fissured, Greenstick, Impacted, Linear, Simple, Slipped Epiphysis, or Spiral

9. Traumatic Fractures Fifth Digit: Segment of the Bone
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Traumatic Fractures
Fifth Digit: Segment of the Bone
Terms include Condyle, Coronoid Process, Ramus, Symphysis, Intracranial, Cervical, Acetabulum, Shaft

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Traumatic Fractures
Traumatic fractures are injuries and therefore must be coded with E codes to report
HOW the fracture happened.
WHERE the patient was when he or she was injured.

11. Multiple Fractures Each fracture is coded separately.
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Multiple Fractures
Each fracture is coded separately.
Report in order of severity—the most severe first.
Report equally severe fractures in order from head to toe.

12. Late Effects of Fractures
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Late Effects of Fractures
NONUNION A fracture that has not healed back together.
MALUNION A fracture that has not healed properly.
Code either of these conditions as late effects of the original injury.

13. Pathological Fractures
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Pathological Fractures
When a fracture is caused by disease rather than injury it is called a Pathological Fracture or Spontaneous Fracture.
E codes are not used with these fracture codes; however, there may be an underlying disease or condition that will have to be coded.

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Stress Fractures
A stress fracture, also known as a fatigue fracture, is often a sports injury.
These are coded from a different area of ICD-9-CM:
733.93, , and

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Follow-Up Care
During the healing process, the patient is typically seen several times.
These should be coded from V54.xx.

16. Dislocations Open or Closed Specific anatomical site
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Dislocations
Dislocations and Subluxations are coded similarly to fractures:
Anatomical region
Open or Closed
Specific anatomical site

17. Dislocations Fourth Digit: Open or Closed
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Dislocations
Fourth Digit: Open or Closed
Open dislocation may be called
compound.
infected.
with foreign body.

18. Dislocations Fourth Digit: Open or Closed
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Dislocations
Fourth Digit: Open or Closed
Closed dislocation is also called
complete.
partial.
simple.
uncomplicated.

19. Pathological Dislocations
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Pathological Dislocations
When a dislocation is caused by disease rather than an injury, it is called a Pathological Dislocation or Spontaneous Dislocation.
Report with Pathological dislocation.
E codes are not used with these fracture codes; however, there may be an underlying disease or condition that will have to be coded.

20. Sprains and Strains A sprain or strain may also be called a(an)
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Sprains and Strains
A sprain or strain may also be called a(an)
avulsion, laceration, tear, hemarthrosis, or rupture
and can occur in a
joint capsule, ligament, muscle, or tendon.

21. Musculoskeletal Diseases
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Musculoskeletal Diseases
Bacterial inflammatory conditions
Metabolic conditions
Degenerative diseases
Chronic diseases
Skeletal deviations
Muscular/Connective tissue conditions

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Chapter Summary
The musculoskeletal system can sustain injury in many different ways: fractures, dislocations, sprains, and strains.
These conditions can be caused by trauma or disease.