alicia: if you're ready, i'll get a drinkand we'll hit the first one. icd-10-cm and fractures... one of the unique things abouticd-10-cm and fractures is you're able to teach a lot of concepts in icd-10 with fractureslike in icd-9 diabetes. we could use diabetes to bring out several scenarios and cases,so fractures there's some good points to bring up.
q: open fracture coding in icd-10-cm use a7th character to explain the severity. how is this 7th character determined? a: let's go talk about that, icd-10-cm 7thcharacter with fractures. now, the one thing that most of you probably already know ifyou're working with icd-10-cm is the fact
that you're able to have up to 7 charactersand they're not called digits like they were with icd-9 they're called characters; so the7th is going to be that last digit. usually it is to indicate whether it's an initialencounter or a subsequent encounter or maybe sequela which stands for late effect. butwith the fractures, this 7the character -- oh, not only tells if it's an initial encounteror a subsequent encounter it also is going to use a classification system called thegustilo-anderson classification system, and it gives you two vital pieces of information. one is: what is the likelihood of your patientdeveloping an infection because it's an open fracture.
now, if you're not familiar what the differencebetween a closed and an open fracture is, an "open" simply means the skin is open; thereis an open wound, and most of the time the bone has caused that. it has poke throughleaving the door for infection. and because the bones run out throughout your entire body,if you get an infection in the bone and you've got blood parts that are made in the bonemarrow, it can be a really big time, bad thing real fast. so, it's something that they takeseriously and they are very cautious with. 1) what's the likelihood that this is goingto cause an infection? 2) how long is it going to take for that fracture to heal? now, there'skind of a standard on fractures. if it's just a simple fracture, but if it's a compoundor an open fracture chances are you're looking
at pins and things and some surgery to debrideor clean that area up, so we could take a little bit longer. it usually means it's amore severe fracture if it's actually broken through the skin. as the grade goes up on this classificationsystem, the infection rate rises dramatically, and lengthens the time for the fracture toheal. because you know most of the time a person doesn't have to take antibiotics ifthey've got a fracture, but if you've got an open fracture you're most likely to beon antibiotic. grade i open fracture injury, let's say ofthe tibia has less than 2% infection rate (with proper treatment), and takes an averageof about 4-5 months to heal. but, if you move
down to grade iiib and iiic (which i'm goingto break this down for you), fractures have up to 50% infection rate and takes an averageof 8-9 months for bone healing. that's a huge difference. let's see what divides these types up: typei - is simply that the wound is 1 cm. then, you've got type ii is 1-10cm. we're talkingcentimeters not inches, so keep that in mind. then, type iii a, we have greater than 10cm, high energy (meaning it was a high energy break, the impact, or however you want tosay that) and adequate tissue for coverage. there's adequate tissue to cover and stitchthat all back up for that open wound. type iiib -- extensive periosteal strippingand requires free soft tissue transfer. this
is much more intense. then, we have type iiic- vascular injury requiring vascular repair. again, you can see why 50% infection rateand it takes 8-9 months for bone healing; a much more severe break, much more complexwound. let's see an example down below. this codehere s82.101b, with "b" being our 7th character, is the code that we'll use for this case:mrs. green is brought to the ed with an open fracture of the right lower leg. x-rays revealedtibial break. the patient's husband stated he saw exposed bone, then it went away. thereis an open wound of 5 cm in length 3 inches distal to the knee. an orthopedic consulthas been ordered. we're just worried about the diagnosis notwhether its inpatient er and all this other
stuff, we're just going to talk about thebreak itself. so, we have an unspecified fracture (because we don't know what type of a fracture),meaning was it a spiral fracture, was it a compound fracture, was it a greenstick fracture?all of those types of fractures are listed in your icd-10, not in the icd-9. unspecified fracture of the upper end of righttibia, initial encounter- because this is the first time they came into the er -- foropen fracture. and we know it's an open fracture because the husband stated he saw the boneand then it went back in, which is common for open fractures. type i or type ii, whichhad 5 cm, which means that up here when we look at this were between 1 and 10 cm, soit is a number ii. and initial encounter,
again for open wound fracture, not otherwisespecified. this is in little print in your books. if you go in and look at s82.101 in your tabular,of your icd-10, you'll see this fracture. now, this is not really a good picture ofthat because this is not a 5 cm wound, but that gives you an idea of what we're talkinghere, where that wound is. the appropriate 7th character is to be addedto all codes from category s82. this is s82 because it's look, s82 right there -- unlessotherwise indicated. this right here is a breakdown of that category, this is on page...if you have the 2014 icd-10 draft it's going to be on page 899. just note that.
this states: b initial encounter for openfracture type i or ii, initial encounter for open fracture nos. and i just happen to havea document camera, let's see if i can get that to slide over. i might have to make itsmall here.... ok, so this is what this looks like, here is our s82 and it tells you fracture of upper end of tibia. we have theright side unspecified fracture -- meaning it's not displaced, it's nondisplaced, andthere's different types. it is unspecified fracture of upper end of right tibia. we knowit is upper end because that was explained. s82.101. then we're shown here that we have to havea 7th character, so this directs us over here,
7th character, right here. the appropriate7th character is to be added to all codes from category s82 -- so it starts with s82you're going to have a 7th character. so, when you're testing and you get right hereand you see this little box that says check for the 7th character and it doesn't haveone, then it is not the right answer. and we went with b - initial encounter for openfracture type i or ii, and it would also be for initial encounter for open fracture nototherwise specified. when you look here, look at how many choicesyou have, and it gets all the way down from initial encounter, subsequent encounter andsequela (meaning: late effect). but you can have subsequent encounter for an open fracturetype -- then it shows those with malunion
(meaning: the bone is not going together well),and then here is nonunion. nonunion, malunion. ok? that's what it looks like in icd-10 draft.one more thing i wanted to know before we went to the next slide. see this notation?we've got s82; we know we're in the right area: a fracture not indicated as displacedor nondisplaced should be coded as displaced.
Icd 10 Code Diabetic Foot Ulcer,that is a guideline, you need to know that.you don't have to have it memorized, you just need to know that if you're in this area andthere's a note, you better read it. and then the "includes" and the "excludes." make apoint to pay attention to those. ok? that's it for that slide.
Since you now know how to control your trouble, you are far better ready to create the correct alternatives and changes in your lifetime. Keep in mind that these pointers will only be pertinent if you use as the majority of them as you can, and so you ought to commence right now to see fast outcomes.
No comments:
Post a Comment